Service Dog Application

Application Date *

Veteran's Name *

Email Address *

Home Phone *

Cell Phone *

Business Phone *

Best Time to Call - AM to PM (Please list work number only if it is okay to call you there.) *

City *

State *

Zip *

City *

State *

Zip *

Are you a Combat Veteran? (Please note you will need to submit a copy of your DD214 & Proof of PTSD or TBI with your application) *

Yes No

(Please list work number only if it is okay to call you there.) *

Yes No

How old is your dog? *

What is your dogs breed? *

Is your dog up to date on all vaccinations? *

Yes No

Is your dog spayed or neutered? (K9BB requires all dogs to be spayed or neutered) *

Yes No

Reason for needing a service dog? *

Are you wanting a Small, Medium, or Large dog? *

Do you have a breed preference? *

What type of activities will the dog be performing with you? *

What energy level would match your life style? *

Low Energy Medium Energy High Energy

Do you have any physical disabilities that will limit your interaction and training with the dog? *

Do you have other pets at home if so what are they? *

Adult - Ages *

Children - Ages *

Do you travel for work? *

Yes No

Where will this dog spend most of his time? *

0-4 hrs 4-6 hrs 6-8 hrs Over 8 hrs

Are you familiar with crate training? *

Yes No

Would your dog be crated while you are not home? *

Yes No

Is there an Adult home during the day? *

Yes No

Is there an Adult home during the night? *

Yes No

Who cares for your dog/puppy while you are away for more than a day? (Kennel, neighbor, family, etc.) *

If you rent, do you have permission from your Landlord to have a dog? *

Yes No

Name & Phone of Landlord *

Would you consider your home? *

Extremely Active Somewhat Active Quiet

Do you have Senior Citizens living in the home? *

Yes No

Do you have children/children visiting often? *

Yes No Occasionally

Ages *

What portion of your property is fenced? *

All Some No Fencing

If fenced, what type of fencing, including height? If fenced, what type of fencing, including height? *

Has anyone living in the home ever been charged with animal cruelty? No or Yes? Please explain. *

List ALL pets you currently own and spay/neuter information on all pets *

Please list your current veterinarian, including contact information. *

Please list two references and their contact information *

By indicating yes below, you are certifying that the above statements are accurate. *

Yes

Name *

Date *

I understand that any dog I obtain will not be perfect. I must give my new dog/puppy plenty of time to adjust. The adjustment period could be anywhere from one month to 6 months, sometimes longer. I will be required to spend a lot of time and energy training and exercising my new dog. It will necessary for me to teach him/her the rules of the home if I expect him to adjust properly. I will not expose him/her to lots of new people, places or pets until he has had the opportunity to become comfortable with his new surroundings and family. He must not be exposed to strangers and especially children until I have formed a bond with him/her and are fully aware of his temperament so as not to put anyone in danger. Dogs are animals and therefore can be unpredictable. I will attend the required training sessions with the K9BB trainer assigned to me. I also understand that if my trainer and/or team of K9BB trainers determines that the dog cannot pass the public access test or meet other legal service dog requirements, that I will have the opportunity to retain the dog as a pet, and that this option will be decided by K9BB staff. I also agree to adhere to the guidelines set forth by K9BB for the training of the dog, and at any such time that these guidelines are not adhered to there can and will be consequences including dismal from the K9BB program and subsequent removal of the dog in question. I will not take the dog out in public with a vest until such a time as my trainer determines the dog is ready for public access. *

I agree with the terms above.

Vet Check *

Pass Fail

Heart Guard *

Yes No

Additional Comments and Concerns *

Signature K9 Battle Buddies Staff *

Max file size: 20MB

Date *

I ___________________________________________ agree to the above terms of this adoption. (Print name) *

I ___________________________________________ agree that for if for any reason I am no longer capable of taking care of this dog, I will return the dog to the K9 BATTLE BUDDIES program. *