Community Service Dog Full Application

First and Last Name*

Would you be the dog's handler?*

Yes
No

Email Address*

Phone*

Full home address including state and zip code*

Name and full address of location where the dog would provide community service*

Have you ever received a dog from Canine Assistants?*

Yes
No

What's the average age of population the dog will serve?*

What specifically motivated you to want a Community Service Dog?*

How important is it to you for your dog to be happy?*

Why is it important that your dog is happy?*

What is the difference between cooperative and being obedient?*

Which is more important for you to see in your dog, cooperation or obedience?*

List the circumstances under which you would return your dog to Canine Assistants.*

It is okay for people to use animals as they see fit.*

Strongly Agree
Agree
Disagree
Strongly Disagree

Please explain your answer.*

Order is important to me.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Dogs reduce my stress.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Moving can be as difficult for dogs as it is for people.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Pets are family members and should be treated as such.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

It is normal for people to talk to their dogs, even in public.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Dogs are thinking beings.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Dogs are emotional beings.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

I am patient with young children.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Chaos bothers me.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

I think all dogs are adorable.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Dogs should sleep in bed with their people.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

I like being around dogs, even when they aren't well mannered.*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Describe your perfect dog.*

What would the dog's typical work day look like?*

Does anyone living in your home smoke?*

Please list the names, ages, and relationship to the handler of everyone living in the handler's home.*

Do other animals live with the applicant or visit them frequently? If so, please describe (including breed, gender and age). Who is responsible for the care of these animals?*

Does anyone in the applicant's household have concerns about having a community service dog such as allergies, fleas, shedding, etc in their home? If so, please describe.*

Are there any areas of your home, including furniture, where your community service dog would not be allowed?*

Where would the applicant like their community service dog to sleep?*

Is the applicant available to attend a one week camp at Canine Assistants?*

Yes
No