Lifeline Assistance Dogs Intake Packet
We know that applying for a working dog is a difficult decision that carries a lot of social, financial and medical repercussions. We're honored that you've chosen LAD to potentially provide your future partner. Please answer all of the following questions in as much detail as possible.

All questions should be answered for the person wishing to partner with a working dog. If that is a child or a person under your guardianship, answer all questions with the word "you" about them.

NOTE: A $150 application fee is required with the submission of the intake packet. Application fees can be paid via PayPal (to info@lifelineassistancedogs.com ) or via invoice upon request. Intake packets are not reviewed until application fee is paid.

What type of dog are you seeking? *
Name *
First and last name
Your answer
Email *
Your answer
Phone number *
Your answer
Physical Address *
Your answer
Mailing Address *
Your answer
Please list all human household members. Include age, name, and relationship to applicant. *
Your answer
List all pets living in/around the household (including birds, small animals, horses and outdoor/working animals). *
Your answer
Do any of the animals listed above have any health or behavioral concerns? Please detail:
Your answer
Do you have ay regular visitors to the home? If so, who? If so, what are their ages? *
Your answer
Is anyone in the home afraid of dogs? *
Is anyone in the home allergic to dogs? *
Does everyone in your home support your decision to obtain a service dog? *
How did you hear about Lifeline Assistance Dogs? *
Your answer
Have you partnered with a LAD in the past? If so, when and what was/is their name, breed and ID number? *
Your answer
Information About You (or your child)
What is your primary disability? *
Your answer
What caused your disability and at what age? *
Your answer
Is your disability potentially life-threatening? *
List all other medial concerns and secondary disabilities: *
Your answer
What is your current height and weight? *
Your answer
Which of the following are the effects of your disability? Check all that apply. *
Required
Do you have any issues with any of the following? Check all that apply. *
Required
How often are you hospitalized? Taken to the ER? *
Your answer
Do you use any of the following in your day-to-day life? *
Required
What medications are you currently on and why? What medial treatments do you currently use? *
Your answer
Have you served as a member of the Armed Forces? If so, what branch? Do you still serve? *
Your answer
What is your primary reason for seeking out a Lifeline Assistance Dog working dog? *
Your answer
What are three things you would change about your day-to-day life as it relates to your disability? *
Your answer
What are your 3 biggest fears day-to-day now, without a service dog? *
Your answer
List 10 words that you feel describe you. 5 must be attributes you feel are positive and 5 of the words must be attributes you feel are negative. *
Your answer
Your Healthcare and Providers
Please list all current medical providers. Include their name, role/title, how often you see them, and how long you have been seeing them. *
Your answer
Your Dog Experience
Have you ever owned a dog? If so, how many dogs have you owned? When did you own each dog? What kind of dog? How long did you own the dog? Why do you no longer own the dog? *
Your answer
Did you take care of the dogs listed above? If so, which ones?
Your answer
How well trained were the dogs that you owned? Who trained them? What methods were used?
Your answer
How were your dog(s) disciplined?
Your answer
What are your 3 favorite breeds of dogs? Why? *
Your answer
Do you have a gender preference? Why? *
Your answer
Do you like small, medium, or large dogs? Why? *
Your answer
Do you like long or short hair dogs? Why? *
Your answer
Your Dog Desires
What would be your dream dog? *
Your answer
Pick words/concepts that would describe the dog you would like to own: *
Required
Pick 5 of the following words/concepts that would describe a dog you would NOT like to own: *
Required
List the tasks you would like to see your dog perform. Understand that your dog's price is determined in part, by their task list. Do not let that daunt you, though - choose your tasks freely and we'll figure out a solution that works for you. *
Your answer
Please detail anything else you would like us to know about your past dog ownership and your desires, dreams, goals and wishes as it relates to you/your child's future partner. *
Your answer
Your Home Life
What type of home do you currently reside in? *
Do you own, or rent your home? *
Do you have a fenced in yard? If so, please detail the type of fencing and size of yard. *
Your answer
If you do not have a fenced in yard, how do you plan on exercising a dog? Please note: a fenced in yard is NOT a requirement.
Your answer
What's the closest metropolitan city to your home? *
Your answer
Describe your home life. Is it quiet? Chaotic? Bustling? Calm? Noisy? Please be as detailed as possible. *
Your answer
Describe your neighborhood and its location. Is it rural? Close to a major road? Lots of children? *
Your answer
What is the approximate square footage of your home? *
Your answer
What does a normal day in your life (or your child's life) look like? Please detail hour-to-hour, from the time you wake, until you go to sleep. Include any overnight information as well. *
Your answer
What does a normal week look like? Tell us about regularly scheduled activities, appointments, and happenings. *
Your answer
Are there any other regular events/activities that occur on a less frequent basis, such as monthly or annually? If so, what? *
Your answer
Is there anything else about you/your child's home life we should know about? *
Your answer
Your Activities
What are some of your/your child's favorite ways to spend free time? *
Your answer
What are some of the ways in which your family spends free time together? *
Your answer
Do you or anyone else in your family play sports? If so, which ones? *
Your answer
What place do you frequently visit? For example, do you/your child/your family enjoy going to the movies?Eating out?Attending church? Going to the mall? *
Your answer
Are there any special activities that the family/you/your child commonly participate in? Examples include martial arts competitions, the rodeo, concerts or summer camp. *
Your answer
Outside of traveling,what other places do you frequently visit? What other activites do you frequently participate in? *
Your answer
Do you exercise regularly? If so, what kind of exercise? Where do you exercise? *
Your answer
Your Transportation and Travel
Do you own your own vehicle? If so, what is the make, model and year? *
Your answer
What other types of vehicles are in the family?
Your answer
Do you (or does your child) ever take public transportation? If so, how often? *
Your answer
Do you ever travel by air? If so, how frequently? *
Your answer
Do you take vacations? If so, how often? To where? *
Your answer
Do you regularly travel for work, school or personal reasons? How often? Where do you travel? How do you typically travel? *
Your answer
Your Team Training
Team Training is the orientation, training session and process by which you/your child will be trained to work with, communicate with and function with your/your child's new partner. You/your child will learn to function with your new dog as a team in public, at home, at work and at school, as well as all other venues you/your child regularly participate in.

Team Training is typically a 10-14 day process. It includes intensive classroom work and multiple field sessions. You can expect Team Training to take 4-8 hours every day throughout the process. The length of Team Training depends on the type of dog, the disability in question, and the individuals themselves.

There are two options regarding Team Training. You may travel to Lifeline Assistance Dog headquarters in Gilbert, Arizona, or you may request that a LAD staff member travel to your home. If you travel to LAD headquarters, you are responsible for your own room and board, and transportation. If we travel to you, you are responsible for our lodging (must be pre-arranged and program approved), travel (must be pre arranged and program approved), transport and a $300.00 stipend. The stipend must be provided at least 3-5 days prior to the start of Team Training.

Lodging must consist of a stay in a 3-star or better hotel for the entire duration of Team Training session. Alternate arrangements will be considered on a case-by-case basis. All lodging and travel arrangements must be made in advance of your Team Training session and for two dogs, your service dog and a LAD demo dog.

Please indicate your Team Training preference. *
Recertification
Recertification is mandatory annually for the first 3 years a team is functioning in the field. Recertification may be completed either in Gilbert, AZ at LAD headquarters, or at your location.
Please select your recertification preference. *
Final Notes
Congratulations! The hard, time-consuming part is over.

After you submit your application, along with the application fee, one of our staff members will be in touch shortly. If you have any questions in the meantime, please shoot us an email at: info@lifelineassistancedogs.com .

NOTE: A $150 application fee is required with the submission of the intake packet. Application fees can be paid via PayPal (to info@lifelineassistancedogs.com ) or via invoice upon request. Intake packets are not reviewed until application fee is paid.

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