Applicants Legal Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Primary Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Name of person completing this form: *

First Name

Last Name

All information submitted is true to the best of my knowledge and I understand that if I have not been truthful my application may be revoked. *

Agree

I acknowledge that I have read and understand the Program Admission Information about the application process. *

Agree

I agree that if K9 Guardians deems necessary I will agree to a background check *

Agree

Agree to be added to newletter *

Agree

Please note: REDACT SOCIAL SECURITY NUMBER FROM THE DD-214 member 4 copy and include the DD-214 with a doctor's letter, and an essay on what a service dog would mean to you. This is required within 30 days of receipt of this application. If we do not receive these items your application will be put on hold and you will lose your spot in the application process. We can not make a decision on your application until these are received. We will also need a video of your home and yard sent to us for our records. *

In some instances we can extend this term. Please communicate with us if you are having issues.

Understand