Service Dog Application

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Personal Information

To qualify for our program, you must meet the following basic criteria (other criteria may be accepted or requested on a case by case basis):

  • Verifiable diagnosis including but not limited to PTSD, TBI,  SCI, physical impairment(s), autism, seizures, and/or diabetes. Every individual will be evaluated on a case by case situation to determine if HTAR Service Dog Program is an ideal fit. A written script from the treating physician for which the service dog is needed for, will be required.
  • Stable living environment
  • Free of substance abuse,
  • Free of a conviction for any crime against animals or humans.
  • Ability to attend weekly training sessions at a pre-determined location (often times on a week day but subject to change)
  • A dog that was rescued, between the age of 9 months to 3 years, no known aggression or reacitivity, fully up to date (DHYPP, rabies, boardatella, and on prevention), spayed/neutered (if 9 months then must be done by 12 months). This dog will be assessed prior to begining any class and is subject for removal from the program if unable to meet the service dog requirements. 

The following documents are required to apply for a service dog through

1. Completed application for service dog

2. Signed prescription from you medical doctor and/or psychiatrist verifying your diagnosis and any other mental health diagnoses relevant to your participation in this program. This script must be current and signed within the last 60 days before submission of this application and must state the need for  a service dog

3. If you have other animals, proof of their medical records that they are up to date on all vaccinations, preventative medications, physical exams and vetrniary information

4. If you do not have a dog to enroll in the program and will be receiving a dog from HTAR, you will need to complete an adoption application as well as a service dog application

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  Happy Trials Animal Rescue does not discriminate on the basis of race, color, creed, national origin, sex, age, religion, marital status, sexual orientation, gender identity or expression, veteran status, HIV/AIDS status, physical or mental disability. Everyone who applies is not guarenteed a service dog, it is based on his/her qualifications. HTAR reserves the right to deny any candidates based on his/her qualifications and/or any other pertinent information reguarding the potential home/handler.

Personal Information

Physical and Emotional Attributes

Please indicate your physical ability to use the elements below using a scale of 1 (being no use) up to 10 (full use)

Fear of Falling

Please indicate your concern regarding the following area ranging from 1 (no concern) to 10 (extremely concerned)

Daily life Questions

Please note any specific difficulties with the items listed below

History


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