Service Dog Training Application Best Dog Daycare in Pottsville, AR Name Street Address City & State Zip Code Home Phone Cell Phone Other Your Email Preferred method of contact Date of Birth Sex MaleFemale Height (Feet & Inches) Weight (LBS) Parent/ Guardian Name(s) School Information (if applicable) School Name PublicPrivateOther School Street Address City & State Zip Code School Office Phone School County School District Have you ever raised a puppy before? YesNo Have you ever raised a puppy with the intent to become a service dog? YesNo If yes please explain: Lifestyle Information (to be completed by parent or guardian if under 18) How many hours a week are you working or in school? You currently reside in a: HouseApartmentDuplexOther If Other, please describe Your residency currently has a Fenced YardEnclosed AreaOther If Other, please describe With whom do you live? Please list all other people living in your home. Include: Name, Relation, Sex – M or F, Date of Birth 1) 2) 3) 4) Have you ever owned a dog? YesNo Do you have any current pets? YesNo Include: Breed, Name, Age, Sex 1) 2) 3) 4) Is anyone in your home allergic to dogs or pet dander? YesNo If so, describe: Describe your typical daily schedule. When do you get out of bed in the morning? When do you retire in the evening? On a scale of 1-5 (1 = low, 5= high), describe your: Activity Level: Anxiety: Independence: Time Outside House: Busyness of daily schedule: How much exercise, on average, do you think a dog needs per day? Describe your definition of exercise. Additional Service Dog Help Who will help you with the dog’s care if you are sick and cannot get outside: Name: Phone: Proximity to your home: Do you have any concerns regarding owning a service dog? YesNo If so, describe. Do you agree to participate in all instructions given by trainers with consistancy? YesNo Are you willing to participate in ongoing training sessions after receiving a service dog? YesNo Will your family accept a trained dog as an equal partner in your house? YesNo The information on this application is correct to the best of my knowledge. Applicant Name: Date: Relationship to Applicant: Δ Dog Daycare, Boarding & Training in Pottsville, AR. Hours of Operation Mon - Fri 7am - 7pm Sat & Sun 9am - 3pm Contact Us (479) 777-0974 email@example.com 606 Edwards Rd. Pottsville AR.