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All rights reserved, A New Leash on Life, a  501(c)3  non-profit corporation 26-2724792, October 2015
At Your Service
   emotional support & service dog training
Name
Phone Number
Email
For Military Applicants
If yes, please explain
Has a doctor recommended a service animal to alleviate a condition? If yes, please explain
Please describe your limitations and how they affect your daily life.

Application Form
Do you currently have any pets at home? Please list species, breed, age and sex.
Have you ever had to re-home an animal?
If yes, please explain
How many people live in your household?
Do children live with you / frequent your household. If yes, what age(s)?
Are the other animals spayed or neutered?
Is your property fenced?
Free Training Opportunity
Our "At Your Service" program provides free dog training to veterans and children in need of additional support. Classes will be held on Wednesdays and Saturdays. Applications are currently being taken.

Is the applicant an adult or a child?
Are you a military veteran?
Are you a combat veteran?
Are you currently in the Armed Forces?
If yes, duty location
Do you use anything to assist in walking, standing or stability?
What type of training are you looking to gain? (check all that apply)
If you are looking for Service Dog training, what function will they provide? What assistance are you looking to gain?
Medical Information
Animal Questionnaire
Do you already have a dog to begin training with?

If yes, what breed & age?
If no, please answer the questions below
Do you have a preferred dog in mind?
If yes, preferred breed, size or weight range of dog?
Have you considered financial cost of owning a dog. What do you think that annual cost will be?
YesNo
YesNo
YesNoN/A
YesNo
YesNo
YesNo
Canine Good Citizen
Emotional Support
Public Access
Service Dog
YesNo