Apply Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Character Reference and phone number * Are all members of your household in agreement with this adoption? * Yes No Don't know Who will be the pet's primary handler? * Have you ever owned a dog before? * Yes No Have you ever been diagnosed with a psychiatric disability? * Yes No Are there any concerns you have bringing a dog into your home? Are you looking for a psychiatric service or therapy dog? * Are you looking to train a dog you already own? * Thank you!