Service Dog Application | Michael's Angel Paws

Michael's Angel Paws

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Service Dog Application

Which option do you prefer? Please select one of the following.

Application Information

First and Last Name

Cell Phone

Text Messaging

Address

Date of Birth

Home Phone

Gender

Martial Status

How did you hear about us?

I would like to be added to the Pawsitively Happenings Newsletter!

Occupation/Education Information

Are you currently employed?

Yes

Do you work?

Full time

Part time

Name of Current Employer

How many hours per week do you work?

Are you currently attending school?

Yes

How many hours per week do you attend school?

Name of School

Do you attend school?

Full time

Part time

Household Information

Do you live in a

How many years have you lived at your current resident?

Does anyone in your household have any allergies to animals? If yes, explain.

Are you the homeowner?

Yes

Landlord's First and Last Name

Does your current residence allow pets?

Yes

Landlord's Contact Number

Do you have any pets currently living at your residence?

Yes

Please list all pets' names, breed/species, and age.

Military Information

What is your military status?

Active Duty

Disabled Veteran

Veteran

N/A

What branch of the military did you serve?

Service Dog Inquiry

What type of Service Dog? (Mobility, Medical Alert, other)

Do you have a medical referral?

Yes

Why do you need a Service Dog?

What special task(s)/skill(s) would you expect from your Service Dog?

What is your ultimate goal of having a Service Dog?

Your Dog's Name

Breed, Weight, and Sex

Date of Birth

Microchip #, if applicable

Veterinarian Name, Address, and Phone Number

Has your dog taken part in any training prior?

Yes

Name of Trainer/Company

May we contact your previous trainer? Please include company name, trainer's name, and phone number.

What type of “misbehaviors” does your dog do? How do you correct your dog when he/she misbehaves?

Has your dog show any signs of aggression or has a bite history? Please explain.

Any additional information about your dog.

Thanks for submitting!

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Michael's Angel Paws

Michael’s Angel Paws is a Nevada tax-exempt, IRS approved 501c3 not for profit organization that was inaugurated in October 2012. We train dogs to help people have better lives through education and compassion.

Donate

About
Services
Class Schedule
Events
Volunteer
Contact
FAQ
More

Use tab to navigate through the menu items.