Operation at Ease, Inc.

Emotional Support/Service Dog Program Application

Items marked with an * are required entries

Name *
Phone *
Address *
Name of an emergency contact person: *
Name of an emergency contact person:
Emergency contact phone number: *
Emergency contact phone number:
Can you provide us with a DD214? *
Do you own your home or rent? *
Do you own your home or rent?
If you own your home can you provide proof of ownership?
If you rent can you provide you landlords name and contact information? If so, please do so below.
Are you currently receiving any VA benefits? *
Do you have any health issues that you would like to have a confidential conversation with our application evaluators about? *
Health concerns will not prevent you from getting a dog from us, however we need to be aware of any issues that might be a factor in helping us choose the proper dog for you.
Can you provide a letter from a health care provider stating you require or would benefit from a service animal? *
Are you currently employed? *
Will you require your PTSD Service Dog to accompany you to work? *
How social are you? *
How often do you exercise? *
Do you currently have any other animals living in your home? *
If Yes, how many? *
Are they current on their vaccinations?
Are you willing to commit to attending 6 months of dog training classes (one class per week)? *
Do you believe your current situation will allow you to keep a service dog for at least 8-10 years? *
Will your service dog spend most of its time with you both at home and outside of the home (and not confined alone/by itself). *
Do you understand that a service dog is not a family pet and has been trained for specific jobs to perform for you and should therefore interact mainly with you? *
Do you acknowledge that by taking one of our service dogs, you are a representative for Operation At Ease and the service dog industry and will be expected to maintain both your dogs training skills and your skills as an owner/handler? *
Do you agree that your service dog will not be off its leash except in a secure area? *
Do you agree that you will take full responsibility for the care of your service dog as far as their safety, health & welfare? And if you are not able to take full responsibility for these things, a qualified person will do it for you? *
Will you or a qualified person feed your service dog a good quality dog food twice a day and maintain its ideal weight? *
Will you or a qualified person ensure your service dog gets daily exercise? *
Will you or a qualified person take full responsibility for cleaning up after your dog in public places? *
Do we have your permission to contact anyone who is listed on this application if we need further information? *
When are you available to attend classes? *
The Operation At Ease training center is located in Rotterdam, NY. Upon successful completion of classroom training we begin Public Access training, which is done at various locations in the Capital District. Do you have reliable transportation to get you and your service dog in training to and from all training and public access classes for a 6 month period? *
I understand that, if I do not complete this program in it's entirety, my dog will not be designated as an Operation at Ease, Inc. trained service dog. It will be considered my pet and will remain in my care. *
I _____________________________(print name) have answered all sections honestly and to the best of my ability.