Green Cart Farm - Assist Dogs Cornwall - Assistance Dog Application

ASSISTANCE DOG APPLICATION

Assist/Service

ASD Companion

Emotional Support

Therapy

School or Community Therapy Dog

Not sure

Assistance/Service Companion and Emotional Dogs are trained to work with one person.

Therapy/Community dogs are trained to work with many people in classroom or community settings.

First Name*

Last name*

Email*

Age of Applicant

Diagnosis

Do you have a direct payment or care package? Assistance Dogs qualify as disability aids.

Do you reside in Cornwall?

Are you willing to commit 30 minutes a day 7 days a week to the training and care of the dog.

Is you house/flat owned or rented

Are dogs allowed in your house rental agreement?

Is there a garden? Size?

Number of children in household?

Number of adults in household?

Who will be the adult handler of the dog?

Is there an adult in the household able to exercise the dog 30 minutes per day?

Are you able to cover � 50 per month in veterenary insurance and food?

Therapy Dog for School/Community �2500 1 year program

ASD/Companion/Emotional Support �2500 2 Year program

Assist/Service Dog �2500 2 year program

The costs do not include the puppy/dog

Are you able to visit our Centre in Lostwithiel a minimum of 2 times per month for 15 months.

Is there anyone with allergies or asthma in the house?

Full Address

Mobile Phone

Comments

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