The Canine Campus
Training & Wellness Center
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Service Dog Application — Digital Submission

Service Dog Application Digital Submission

Fill out the form below to submit your Service Dog Application to The Canine Campus. 

If you prefer to print a paper version you can access it here: Service Dog Application (PDF).


The Canine Campus — Application for Service Dog

Today's Date: *
Today's Date:
Applicant Name: *
Applicant Name:
Date of Birth: *
Date of Birth:
Address: *
Address:
Home Phone: *
Home Phone:
Work Phone:
Work Phone:
Cell Phone:
Cell Phone:
Marital Status: *
Sex: *
If minor, Adult's Name:
If minor, Adult's Name:
Adult's Phone Number:
Adult's Phone Number:
Name / Relationship to You / Age
Are you a US Veteran? *
If yes, please provide your DD214 to The Canine Campus.
Emergency Contact Address: *
Emergency Contact Address:
Emergency Contact Home Phone: *
Emergency Contact Home Phone:
Emergency Contact Work Phone:
Emergency Contact Work Phone:
Emergency Contact Cell Phone:
Emergency Contact Cell Phone:
What kind of housing do you live in? *
e.g. busy city, country, quiet neighborhood, etc.
Is everyone that lives in the house in agreement about a service dog living in the house? *
Do you or does anyone you live with have any allergies to dogs? *
Note: if you are unable to travel, there will be additional costs associated with travel for final training with you.
Do you have a swimming pool? *
e.g. above-ground, in-ground
Do you have a fenced-in yard or an enclosed area outside? *
Have you ever had dogs before? *
Do you have any animals that live with you? *
Species (cat, dog, etc.) / Breed / Age
Do other animals visit you frequently? *
Species (cat, dog, etc.) / Breed / Age
Date of disability: *
Date of disability:
Is your disability progressive? *
Do you have any other medical conditions? *
Have you ever applied for a service dog before? *
Mobility Information: *
Please check all that apply.
Which is your dominant hand? *
Do you have any limitations in your hand or arm movements? *
Disability: *
Please check all that apply.
Do you have any problems with:
Do you have any psychological conditions/disorders diagnosed by a psychiatrist or psychotherapist?
Check all that apply.
What type of service dog meets your needs? *
Do you have time to spend with a dog? *
Are you able to exercise a dog? *
Are you capable of taking a dog to a veterinarian? *
Are you able to groom a dog? *
Are you able to clean up after a dog? *
Are you able to financially afford veterinary care? *
Will a service dog go to work with you? *
Will a service dog go on vacations with you? *
Can you feed your service dog? *
Can you take a dog outside to go bathroom? *
Is there someone to take care of a dog in case of hospitalization? *
Will there be family/friend involvement? *
Will you be able to handle any dog behavior problems? *
Please check highest level of formal education completed: *
Are you interested in having Together Journey choose your service dog? *
If you have your own dog, do you give us permission to evaluate it?
If yes, please include a picture of your dog with this application.
Sex:
Spayed/Neutered?
Relative Reference: *
Relative Reference:
Relative Phone: *
Relative Phone:
Friend or Co-worker Reference: *
Friend or Co-worker Reference:
Friend or Co-worker Phone: *
Friend or Co-worker Phone:
Previous Employer or Teacher Reference: *
Previous Employer or Teacher Reference:
Previous Employer or Teacher Phone: *
Previous Employer or Teacher Phone: