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Service Dog Training Application

Best Dog Daycare in Pottsville, AR

r and r kennels pottsville
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    Sex




    School Information

    (if applicable)

    PublicPrivateOther




    Medical Information

    (to be completed by parent or guardian if under 18)



    Check all medical problems that apply to you:


    Do you have any cognitive difficulties (such as memory problems, inability to concentrate, etc.)
    that would affect your ability to manage a service dog?


    Would any of your current medications impair your ability to manage a service dog or impact
    learning how to work with your dog?


    Do you anticipate future surgery or hospitalization for any reason?


    Do you require the assistance of an aide or family member for daily living skills?


    Are they willing to assist with the daily care of a service dog, if needed?






    Mobility Information

    Is your mobility limited?


    Do you use a wheelchair?

    If so, what type?


    Do you use any other mobility aids?


    Will you want your dog to help support you while you are walking or getting up?


    Is one side of your body stronger than the other?

    If so,


    On which side would you want the dog to work most of the time? (Example: If you are right-handed,
    it is common for the dog to be trained to work on your left so your right hand can be free from leash,
    etc; however, this can change based on stability needs, etc.)


    Are you restricted in the use of your hands or arms?


    On a scale of 1-5 (1 = poor, 5= excellent), describe your:


    Are you able to issue hand signals?


    Do you have spasms in your arms or legs?


    Do you bruise easily?


    Could a dog put his front legs up on your lap without hurting you?


    Are you able to issue voice commands in a clear, audible voice?




    Lifestyle Information

    (to be completed by parent or guardian if under 18)

    You currently reside in a:


    Your residency currently has a



    Please list all other people living in your home.

    Include: Name, Relation, Sex – M or F, Date of Birth


    Have you ever owned a dog?


    Do you have any current pets?


    Include: Breed, Name, Age, Sex


    Is anyone in your home allergic to dogs or pet dander?





    On a scale of 1-5 (1 = low, 5= high), describe your:




    Service Dog Requirements

    (to be completed by parent or guardian if under 18)

    Have you previously owned a service or assistance dog?


    Do you have any experience working with animals?









    Additional Service Dog Help

    Who will help you with the dog’s care if you are sick and cannot get outside:



    Do you have any concerns regarding owning a service dog?


    Are you willing to participate in ongoing training sessions after receiving a service dog?


    Will your family accept a trained dog as an equal partner in your house?








    The information on this application is correct to the best of my knowledge. I understand that
    this preliminary application is required to be eligible for an application package which will
    determine my suitability for a service dog.






    R & R Logo

    Dog Daycare, Boarding & Training in Pottsville, AR.

    Hours of Operation

    Mon - Fri  7am - 6pm

    Sat & Sun 9am - 3pm

    Contact Us

    Call Us: (479) 777-0974

    E-Mail Us: Click Here

    606 Edwards Rd. Pottsville AR.

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