Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.
I consent that I meet all above requirements
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
I understand the required documents
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.
I give consent for a background check to be ran on the adults within the household. It would be checking information that is public record, it will be a level 1 check.
Personal reference (2 who do not live with you)
Do you own your home
Veterinary Reference
Occupation
Place of employment
Please thoroughly describe your work environment. The type of work done there, the types of clients you interact with, the physical environment, the location of the job, indoors/outdoors, etc. Will you be bringing your dog to work?
Please thoroughly provide a description of your job function(s) and what your typical workday looks like.
If working, what is your (and spouses if applicable) work schedule
Where does the majority of your income come from and how much do you earn/receive a year?
If you’re not currently employed what are your future employment plans?
Have you ever been arrested? Please annotate arrest(s) even if it did not result in a conviction. If yes, please explain
Have you ever been convicted of a misdemeanor or felony? If yes, please explain and provide dates.
Have you ever been charged with an animal abuse or domestic abuse charge? If yes, please explain
Are you currently enrolled in school? If so, where are you enrolled and are you on campus (how often) and what degree are you pursuing?
What is your disability (disabilities, please list all mental and/or physical) and how does it impact your day to day life?
How long have you been diagnosed (please put separate dates if more than one and was diagnosed at different times)?
Do you use any medical devices including but not limited to: Wheelchair, Crutches, Cane, 3-wheel Electric Scooter, Sip and Puff, Adaptive Language Device, Headgear, Breathing or Feeding Tubes, Other:
If you use any of the items listed above, how often do you use them or any not mentioned?
What form of transportation do you use? How often do you use it? (Personal Vehicle, Public Transportation (Bus or Light Rail), Taxi Service, Access-A-Ride, Other)
Have you ever had a service dog before? If yes, what were they trained to do, where did you get them from and what happened to the dog?
Do you have a Facebook page? if so, please provide the link below
Please indicate your physical ability to use the elements below using a scale of 1 (being no use) up to 10 (full use)
Left Hand Strength
Right Hand Strength
Left Hand Dexterity
Right Hand Dexterity
Left Upper-Body Strength
Right Upper-Body Strength
Left Leg Strength
Right Leg Strength
Core Strength
Please indicate if you have any previous amputations, injuries, or impairments that cause difficulty with your physical ability to perform your day to day activities:.
Please indicate your concern regarding the following area ranging from 1 (no concern) to 10 (extremely concerned)
A Risk of Falling
A Risk Of Not Being Able To Catch Yourself If You Fall
A Risk Of An Inability To Get Up If Having Fell
A Risk Of An Inability To Call For Help If Needed
Please indicate what your primary fears are including but not limited to causes of falls etc. Please explain how often you fall, how you get back up if you fall, and if someone is typically around you when you fall.
Please note any specific difficulties with the items listed below
Finances
Housecleaning
Meal preparation
Dressing
Bathing
Shopping
Rearing children and/or pets
Remembering to take medications
Opening doors
Sleeping
Retrieving items (if so what type of items)
Being out in public/leaving the house
Managing my condition (if so please explain in detail)
Do you have an individual (be it family, friend, or hired assistants/caretakers) that assist you with your occasional or day to day life? If so, please provide information as to how often and for what tasks they assist
How does your disability affect your daily life? What are your functional limitations?
If applicable, in your own words, how would having a service dog help you throughout your daily tasks and activities, be it physical or psychological?
What types of therapies and/or programs have you attended in the past? What were they addressing? What do you feel helped and did not help with any of them?
Are you currently receiving any therapies or programs? If yes, what are they are for how long will you be attending?
How do you deal with your anger and stress?
Please list the most common triggers for your anxiety/PTSD (if applicable
Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.