4 Paws 2 Freedom Online Service Dog Application
Service Dog Application for Training
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4 Paws 2 Freedom considers all applications regardless of race, sex or religion.
Name (first and last) *
Street Address *
City *
State *
Zip *
Phone *
Email Address *
Name of Alternate Contact Person *
Phone Number of Alternate Contact Person *
Are you a veteran? *
Are you active military?
For veterans only
Are you a combat vet?
For veterans only
How long did you serve?
For veterans only
Where did you serve
For veterans only
When were you discharged?
For veterans only
MM
/
DD
/
YYYY
What Branch?
For veterans only
How long have you been back in the United States?
For veterans only
Are you a student at Sierra College, Rocklin or Nevada County Campus?
Clear selection
Date of Birth *
MM
/
DD
/
YYYY
Where did you hear about 4Paws 2Freedom?
Have you ever been convicted of a felony? *
If yes, please explain
Emergency Contact Name *
Relationship *
Phone
Your Occupation
Complete this if you work or volunteer
Employer
Hours worked per week
How does your employer feel about you having a service dog?
Describe how your disability impacts you *
Are you physically able to train your own dog? *
Training requires alot of bending, stooping, reaching, kneeling, standing, walking, sitting as well as other strenuous activity.
How does your primary care doctor feel about you having a service dog? *
Name of your Primary Care Physician *
Address of your Primary Care Physician *
Phone number of your Primary Care Physician *
Are you currently in therapy with a licensed mental care provider? *
How does your therapist/psychologist feel about you having a service dog? *
Name of your Mental Care Provider *
Address of your Mental Care Provider *
Phone number of your Mental Care Provider *
Do you have a dog now who you wish to train to be your service dog? *
Name of dog
If yes, Please answer this and the following questions
Breed
Age
Spayed or neutered
How long have you had your dog?
How old was he/she when you got him/her?
Name of your Veterinarian
Phone number of your veterinarian
How does your dog react to dogs he/she does not know?
How does your dog behave around cats?
Does your dog enjoy being around children?
Have you ever heard your dog growl at a person?
Has your dog ever bitten anyone?
Has your dog ever been injured by another dog?
Does your dog frighten easily, or is he/she jumpy? Please describe.
What pets do you have at home?
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