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Please print this page, fill it out, and either scan it or take smartphone photos and email it to SpecialForcesBravoK9@gmail.com. Please allow us 48 hrs to contact you.

APPLICATION FOR SERVICE DOG (Ex-K9/MWD)

Name ___________________________________DOB______________

PRIOR SERVICE BRANCH

USMC______USN________USAF________ARMY_______CG__________

(Note SFB will NEVER gift a Service Dog to a veteran with anything other than an honorable DD214)

Have you obtained medical recommendation for a Service Dog for Anxiety/ PTSD/ Mobility or

other medical issues?  ____________  If not, please do so before continuing the application

process. Who is your recommending provider? ______________________________

(Name/Fax/Phone)

Do you have any other pets in your home? If so what are they? Can they be rehomed?

__________________________________________________________________________________________________________________________________

(Please note that we will not place a SD in a home with any other non-farm animals)

Have you had a dog in the past? Have you had another Service Dog? Please summarize what became of them if so. __________________________________________________________________________________________________________________________________

Do you have a Veterinarian that you have used in the past? If so please give their name/Phone number.                                      If not, please provide us with who you intend on using, providing the same info.

Do you have reliable transportation? If so will you install a proper travel-safe kennel and restraint system before getting your dog?______________________________________________________

Do you rent or own your home? ________________ Do you have a fenced in perimeter? ________________________________________________________________

Please list the names and ages of all in your household (children included) so that an in-depth background check can be performed on the family and roommates.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you have a history of alcohol/substance/physical abuse? ____________________ If so have you sought help and positive coping skills, or are you still struggling? _________________________________________________________________

Why do you want a Service Dog? How do you believe it may make your life easier/better/add a level of difficulty? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If awarded an SFB Service Dog do you intend on continuing education and self-training through SFB with the assistance of a pre-selected and appointed training center/instructor? YES________NO____________

If your life were to change, you became gravely ill, got a divorce or lost your home, something unforeseen that would cause you to consider giving up your dog do you agree to contact your case manager with SFB so that our organization can make arrangements to retrieve the dog, and acknowledge any failure to do so, or any change of custody of the dog to anyone other than yourself without the approval in written form with the proper notarization form the SFB makes you subject to a $5,000.00 USD fine, and a lifetime ban from our network and sister/brother programs?

YES _________________NO_________________________

Sign/Date_______________________________________________________

Do you have any previous experience with working class dogs? _______________________________________________________________

What made you reach out and apply to our organization? _______________________________________________________________

Do you have a preferred breed? ____________ If so what is it? (Circle all that apply)

German Shepherd         Belgian Tervuren    Belgian Malinois       Belgian Sheepdog                                                                                Dutch Shepherd

Do you prefer a male or female? _________________________

Do you acknowledge that if selected to receive a dog, that SFB will provide the Service Dog, (which passes the AKC Good Citizens test & ADI Service Dog standards) a vest, kennel, UTD immunizations and medical record for this dog and that from the moment you take the dog home and the hand off is complete that you are solely liable for the dogs medical care and vaccinations and boosters per your local, state and federal FDA/USDA guidelines? That failure to provide continued proper medical care for this warrior service dog is inexcusable and subject to removal from your care upon failure to comply with SFB’s guidelines, understanding that SFB will not immediately remove a dog without an in-depth investigation and warning to rectify the dogs health status.

YES____________NO________________     Sign______________________date_________________

Please note that SFB-K9W receives dozens of applications every month, and we like to give each applicant the due respect they deserve as not to overlook or short change their individual needs. You may be approved to obtain a Service Dog with us, and IT may mean that we don’t have the perfect match for you on hand at that time. Be patient. Good things come to those who wait. Our average time of placement from application and case manager assignment is 7 months.

Please note that you will be required to provide your medical referral, a letter of disability from the VA showing your disability percentage, as well as a copy of your DD214. (Please use the space below to add any notes that you may have) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you for taking the time to apply, we will get back to you shortly. Thank you for your service to this country. Know that we are here for you, and that SFB is a family that spans the globe. We look forward to talking to you soon!

Very Respectfully,                                                                                                                                               The SFB family

This application and website WWW.SpecialForcesBravoK9sForWarriors.org is intellectual property of SFB and the board of founders. All material on this site and found in this form is copyrighted and subject to civil litigation if taken and used without prior written consent. ©2018 Special Forces Bravo K9s For Warriors

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