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SERVICE DOG APPLICATION

REQUEST FORM

SACRED PAWS SERVICE DOGS

First Name

Last Name

Email

Phone

Please explain what tasks you are looking for help with from a service dog and how this would improve your overall quality of life.

ARE YOU ACTIVELY SERVING OR A VETERAN OF THE UNITED STATES MILITARY?

YES

NO

Have you been diagnosed with a physical or mental disability from a health professional?

YES

NO

Are you able to take on the added responsibility of caring for a dog or have someone that can support you in doing so on a daily basis? (physically and financially)

YES

NO

Can you attend the required 2 week Team Training in Middletown, Connecticut to learn how to work with your new partner?

YES

NO

Is there anything else that you would like us to know about you?

Thanks for submitting! A member of the SPSD team will be in contact.

#SacredPaws -