Service Dog Programs - My Service Dog

Service Dog Criteria

No matter which program you are interested in: Puppy Program, Train Your Own Dog Program, or Veteran’s Pilot Program, there is a criteria that has to be met to be a part of our programs.

No Bully Breeds or Bully Breed Mixes
Age range is six weeks to three years
Must be healthy and never had life threatening issues (e.g. heartworms)
Must have never shown aggressive behavior towards humans or other animals
Financially able to afford care, preventive, grooming, etc.
30 pounds and up

Companion Dog Criteria

(Companion dog training is only available through the Veteran’s Pilot Program)

No matter which program you are interested in: Puppy Program, Train Your Own Dog Program, or Veteran’s Pilot Program, there is a criteria that has to be met to be a part of our programs.

No Bully Breeds or Bully Breed Mixes
Age range is six weeks to three years
Must be healthy and never had life threating issues, i. e. heartworms
Must have never shown aggressive behavior towards humans or other animals
Financially able to afford care, preventive, grooming, etc.

Ready To Proceed?

Full Name of Disabled Party:*
Disabled Party's Date of Birth:*
MM slash DD slash YYYY
Email:*
Phone*
Does the Disabled Party Live Alone?*
- Yes
- No
Please List Names & Ages of any Parent, Spouse, or Assistant ONLY:
Please List Any Party Under 18 Years Old Within The Home:
Has Anyone In The Home Been Convicted Of A Felony?*
- Yes
- No
List all related and unrelated physical and/or psychiatric disabilities.*
Does the disabled party require any medical equipment such as a wheelchair, crutches, oxygen tank, etc.?*
- Yes
- No
Please List the Medical Equipment:
List any tasks you would like a Service Dog to assist with:
Has the disabled party, or other resident in the home, reacted violently during a flashback, or at other times kicked, hit, bit, or pinched people or animals within the last 6 months?*
- Yes
- No
Please list an average day for the disabled party, such as activities, outings, school, work, etc.*
List any other pets living within the home, including their species, breed/mix, age and gender.
Do you understand that by submitting this application you acknowledge and admit understanding that My Service Dog, Inc. reserves the right to deny service to an applicant for any reason, including but not limited to failure to meet the requirements for receiving a service dog? Do you also agree to hold free from any and all liability My Service Dogs, Inc. and its members and officers? Do you also agree that you, your family, guests, visitors, and members of your household wave the rights and claims for damages and injuries, which may come from your connection and participation with My Service Dogs?*
- Yes, I understand and agree to all of the above.
Signature*
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