APPLICATION FOR CHILD SERVICE DOG
● Applicant is between the ages of 5 and 18
● Diagnosis from a medical provider or psychologist/psychiatrist that would benefit from having a service animal. These diagnoses include but are not limited to: autism, diabetes, any condition involving mobility problems, ADHD, etc.
● There is a demonstrated need for a service dog (versus companion dog)
● Primary and Secondary Caregivers must attend all training sessions and be comfortable handling a dog while caring for your child while in public. Even highly trained service dogs can become distracted and will require directions and commands from the child’s guardian.
● All application documents and acknowledgements completed and signed
● Documentation of a diagnosis from a medical provider or psychologist/psychiatrist that would benefit from having a service animal. These diagnoses include but are not limited to: autism, diabetes, any condition involving mobility problems, ADHD, etc.
● A prescription for a service dog from applicant’s medical provider
o Medical statement of allergies (if requesting a hypoallergenic breed)
● Three statements describing the applicant’s diagnoses, challenges, and needs from extended family members, current service providers, teachers, or friends of the family
● A 15-20 minute video:
o Introducing all members of the residence, house and home environment including the yard
o Showing how the applicant interacts with a dog. It is important for us to see the applicant’s current behavior around dogs. The dog in the video may belong to a neighbor, friend or relative, but if you have dogs in the home, they must be included in the video also
o Showing the applicant in a variety of settings to exhibit a variety of behaviors and/or moods: engaging in preferred and non-preferred activities, experiencing transitions, communicating wants and needs, and a meltdown. It is vital that the trainers are familiar with each applicant’s specific behaviors in order to be able to properly determine the appropriate training curriculum and make the best possible match. All questionnaires, charts and signed acknowledgements.
o If possible, a statement from the child expressing what a service dog means to them
● If there are other pets living in the home(s), include current vaccination records