Working Dog Application : American Pit Bull Foundation

Service Desired*

Please state the specific service/s that you are looking for in a Service Dog.

Have you Previously Owned a Service Animal? If so, please provide a brief description of the services provided and whether that animal aided in your treatment:*

Name of Applicant*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Place of Work:

Work Phone:

Are you Planning on Bringing a Service Dog to Work with You?

Yes
No
n/a

If Intending to Bring to a Job Site, Have you Discussed This With Your Employer Yet?

Yes
No
N/A
I need assistance with this

If you currently own any pets, or have within the past 3 years, please list all, list breed, and whether they are intact, spayed or neutered.

Are you at least 18 years of age or older?

Yes
No

Please list the number of adults in the household

Please list the children in the home and their respective ages

DD214*

Max. file size: 256 MB.

Please upload a copy of your DD14

Veterinarian Information

Regular Veterinarian

Veterinarian's Phone:

Veterinarian Address

Street Address Address Line 2 City State ZIP Code

References

We ask that you provide 2 Personal or Business References:

Name

First Last

Phone

Email

Relationship to this person:

Name

First Last

Phone

Email

Relationship to this person:

General Interest

Was a service dog recommended to you as a good treatment option for PTSD? If so, who made the recommendation?

What other treatment methods have you tried?

Do you currently utilize the services of a therapist or psychologist? If so, please list their information below:

Are you open to us speaking with your therapist regarding your treatment plan?

Yes
No
Maybe

What has interested you in choosing Operation Sidekick for a service animal?*

Is Your Family on Board for Committing to a Service Dog in the Home for Your Treatment?

Yes
No
N/A

Are you familiar with bully breed personalities and overall traits?

Yes
No

What might a typical day look like for you and your dog?

Pit Bulls are a very energetic breed and require a lot of exercise and attention. Are you prepared to spend a lot of time exercising with your Pit Bull?

Yes
No

Taking ownership of a dog/puppy requires a financial commitment to their health and upkeep, (yearly vaccinations, heart worm & flea preventions, food, toys, etc.); are you financially prepared to care for a canine full time?*

Yes
No

Have you ever had to surrender a pet to a rescue, shelter, or animal control facility? If yes, please state circumstances:

Have you ever given a pet away to a friend, family member, or other individual? If yes, what were the circumstances?

Housing & Residence Information

Many properties and home owners associations have restrictions on the number of pets you may have, a weight limit to these pets, and sometimes a breed restriction of the dog that can reside there.

Are you familiar with your property management’s or home owner association’s pet policies?

Yes
No

Are there any concerns you have that we can help address regarding any restrictions where you live?

Please describe your living arrangement

Rent
Own
Other

Please list your landlord name, complex name, and contact information.

Please describe your living situation

Does your property have fencing and, if so, what type of fencing?

(Please note that fencing is not a requirement)

Training & Care

Training is an on-going requirement to keep skills sharp. Are you prepared to continue training with your canine and undergoing an annual test/evaluation to maintain your canine's service dog status?

Are there any barriers you face in working one-on-one with a trainer to learn how to best utilize your service dog?

Do you have any previous experiencing training with a service dog? If so, please describe below:

Will anyone other than yourself be responsible for the care of your canine? If so please list who and what their responsibilities would be:

Where will your canine sleep?

Additional Information

Tell us a little about yourself and make any additional comments regarding this application

How did you hear (or learn) about the dog you are applying to adopt?

Who will be primarily responsible for the care of the adopted dog or puppy?

If I am chosen to be the adopter of this dog, I agree to the following:

I understand that by signing the line below, that I have provided correct information on this application.
Should I adopt an animal from American Pit Bull Foundation and any of the information listed be false, I understand that I am immediately relinquishing ownership back to the American Pit Bull Foundation.
Applicant also understands that the American Pit Bull Foundation is a private corporation which reserves the right to deny adoption privileges to any individual without having to state cause.
APBF does not discriminate against any applicants based on race, color, sex, national origin or religion.

Signature

Untitled