Application Name Title Choose One Mr. Ms. Mrs. Prof. Dr. First Name * Last Name * Email Address * Address including city, state and zip code Contact Number * Can we text you? YesNo Please list names and ages of all living within the home: List the names and ages of anyone living in the home who ever becomes frustrated enough that they would hit, kick, bite or pinch either people or animals. Which member or members of your household will be responsible for the daily feeding, grooming, exercise, and maintenance of your dog? List all other pets including breeds, genders, and ages: List any experiences you've had with dogs in the past such as pets you've had, a friend's dog, and what you gained from these interactions: By selecting an option below, you agree that you have read through the Angel Retrievers' website and understand that you can take classes as often as once per month with your dog. At this time I plan to attend follow-up training classes as follows: (Please only select one.) I will attend just one, all-day course, the day I receive my puppy, so I can leave with an understanding of how to reinforce the training they have already received. After that I plan to receive support through email and written reports. I will attend between 1-3 classes to maintain a high level of reinforcement in training. I intend to attend 4 or more classes with my dog for continous support. I plan to attend classes on a regular, nearly monthly basis, for the first year or so of having my dog. Learning is fun!!! Are you interested in this dog as a pet or Emotional Support Animal? YesNo Would you like your dog to act as a deterrent in your home? * Yes, I would like my dog to bark when strangers approach, but be friendly.No, I would like my dog to welcome strangers without barking. Are you interested in this dog as a service dog, which is trained in tasks to assist with a disability, and accompany you into public settings? YesNo List the name and age of the disabled party below AND all diagnosed disabilities for this individual: * Will you be able to provide medical documentation supporting the disability? * YesNo Do you ever dissociate while walking (moving forward), but are unaware of your surroundings and/or your actions? Dogs can be exercised in many ways. Please select all of your exercise goals: Play in fenced yard with a ball or frisbee Daily walks in my neighborhood Walks in my neighborhood 3-5 times per week Weekend hikes Dog parks Swimming Professional competition sports such as agility, flyball, or dock diving Bird retrieval in a hunting sport Cage-free dog daycare and group play Would you like a dog who enjoys retrieval? Yes, this will be a service dog and in the future I will train the dog to retrieve one or more of the following as a trained task: medicatios, open doors, retrieve a phone, or retrieve items I can't reach, etc. Yes, this will be a pet but I really want to be able to play fetch with my dog as a game or exercise tool. While retrieval can be fun, it is NOT A REQUIREMENT I have, as I want to keep my options open. Check all areas you would consider having your dog sleep at night: Dog house outside Cozy in crate inside my home Cuddling with me on the bed Slumber party with my child in their bed Basically, wherever they want Would you prefer a dog who: Is calmer and would prefer to lie at my feet for hours on end. Is spunky, with a pep in their step - but will still be calm when asked. Have you previously submitted an application to Little Angels Service Dogs (our partner organization) or Angel Retrievers? Yes No Will anyone in your residence be uncomfortable working with other recipients and their dogs in a group setting? Yes No Do you understand that by submitting this application you acknowledge that Angel Retrievers considers all applicants regardless of race, sexual orientation, religion, or creed and that Angel Retrievers reserves the right to deny services to an applicant for any other reason? Do you also agree to hold free from any and all liability Angel Retrievers, Little Angels Service Dogs, and owners, officers, and members of both organizations, agreeing that you, your family, guests, visitors, and members of your household waive the rights and claims for damages and injuries, which may come from your connection and participation with either program? * Yes All information submitted in this application will be considered. If we feel one of our dogs is a good match for you, based on your ability to care for the dog, and which personality and propenseties would be right for you, we will reach out for further communication. Please list any other comments you would like us to consider in the text field below. Thank you in advance for your patience as we review submitted applications. We will be in touch within 1-3 business days. Information Summary