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   Facility Dog Application

This application is for adults who are hard of hearing or have type 1 diabetes and need a Diabetic Alert Dog or Hearing Ear Dog. Note: If you are a veteran, please complete the veteran application. Please carefully fill out this application, only fully completed applications with submitted health forms and reference letters will be processed. Upon receiving your application you will receive an email receipt with links for the additional needed forms! This email will be going to the email provided in the first section of the application.

Once all components of an application have been received, the application will be processed. Upon acceptance the handler(s) is required to meet a fee for service to 4 Paws. Most individuals meet the contribution requirement through fundraising. After you have reached your fee for service, you will be placed in a spot in the next open placement training class to receive your service dog. Currently the wait time ranges between 2-2.5 years until we have open classes.

Client Information

Emergency Contact Information

Diagnosis

Service Dog Information

4 Paws for Ability requires that families maintain a high level of care with their service dog. It is expected that your dog will be fully up to date on all medical care, provided a high quality diet, maintain a healthy weight and be properly groomed. To accomplish this expectation requires a family to be prepared for a cost around $2,000-3,000 each year. 

Service Dog Handling

4 Paws reserves the right to deny services to any applicant which doesn’t meet the
criteria necessary for placement of a service dog or who requires services not
trainable within the guidelines of the agency.

Contact Information:

Jennifer Lutes

jennifer@4pawsforability.org

(937)374-0385

www.4pawsforability.org

APPLICATION MUST BE ACCOMPANIED BY A $50.00 NONREFUNDABLE PROCESSING FEE. If you encounter problems when processing the fee, please immediately email MattFrederick@4pawsforability.org. Thank you!

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Adult Application Fee

Pay with ...

If you have trouble with the payment section on the next page, please submit your application payment using the following link to ensure that your application is reviewed and sent to the next steps.

Please ensure the client's name is entered as well as the same email address used on your application. Thank you!

https://4pawsforabilitystore.org/products/client-application-fee-1

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