4 Paws for Ability | Facility Dog Application

Facility Dog Application

This application is for individuals interested in applying for a Facility Dog. At 4 Paws for Ability, we place facility dogs with individuals employed at educational, healthcare, first responder or visitation facilities. Please note that Facility Dogs are task trained to assist a population rather than a specific individual, and thus are not covered under the Americans with Disabilities Act (ADA) as a service dog. Upon submitting your application, you will receive an email receipt with links for the additional form needed to complete your application. For Facility Dogs, this includes a reference letter filled out by an individual at the facility that can give authority to fundraise or pay for the Facility Dog. Once all components of an application have been received, the application will be processed. Upon acceptance, the client/organization is required to meet their fee for service which goes toward the mission of 4 Paws to breed, raise, train and place service dogs. After you have completed your fee for service, you will move on to our “Awaiting Placement” stage. On average, from the completion of the fee for service, it takes 1.5 - 2 years to be matched and placed with a facility dog. At this time, your organization's designated handler will travel to our facility located in Xenia, Ohio to meet your facility dog and work with our professional trainers for 10 days. To learn more about the Client Process, please visit: https://www.4pawsforability.org/clientprocess/

Client Information

Name of Facility:

Street Address

City

State: (please use 2 letter abbreviation)

Zip Code

Primary Phone

Secondary Phone

Email (This will be referred to as your On File Email Address in the future)

Emergency Contact Information

Emergency Contact Name

Emergency Contact's Phone

Alternate Emergency Contact Name

Alternate Emergency Contact's Phone

Diagnosis

What population do you work with?

What tasks do you think a facility dog could do to make your clients more independent?

What are some of the primary medical conditions of your clients?

How does this affect your client's daily living skills? What are your client's limitations?

What types of adaptive equipment do your clients use? (ie. Wheelchair, crutches, hearing aid)

Facility Dog Information

4 Paws for Ability requires that families maintain a high level of care with their facility 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.

Are you financially able to care for the dog?

Other No Yes

This field is required

Can you physically bathe and groom the dog?

If not, can you afford to pay grooming?

No Yes

This field is required

Please explain the financial situation if you answered "no" or "other" above

Facility Dog Handling

Do you have a handler in mind for the facility dog?

No Yes

This field is required

Handler's Name

Handler's Phone Number

Handler's Address

Anything else you want us to know?

I understand that upon acceptance into the 4 Paws for Ability program, I will need to meet my fee for service which is my contribution towards the cost of the breeding, raising, training and placing of the facility dog.

No Yes

This field is required

I understand that after I have met my fee for service, I will be placed in the next open placement training class which can be at least 2-2.5 years due to class availability as well as the time it will take 4 Paws to breed, raise and train my facility dog.

No Yes

This field is required

I am willing to sign a contract.

No Yes

This field is required

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

Contact Information:

[email protected]

(937)374-0385

www.4pawsforability.org

I agree that I am filling out this application to the best of my ability.

This field is required

Full Name

Today's Date

Once your application has been screened and you are invited to move forward in the application process, a $50.00 nonrefundable processing fee will be required. A link to submit the fee will be emailed to you at that time.

Please note that payment of the processing fee does not guarantee acceptance or placement.

If you encounter any problems when submitting this form, please email [email protected] immediately.

Thank you!

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