Service Animal Application Opus Media July 6, 2017 August 26, 2017 Service animals are placed based on the order of application and which animal would make the right match for the handler. The training fees vary based on the dog being placed. Step 1 of 4 25% Name* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Owner DetailsFor service dogs, what tasks are required to mitigate the handlers disability?For ESAs (only ESAs) do you have a valid recommendation from a medical doctor stating an ESA will help mitigate your symptoms?Why are you interested in adopting one of our trained dogs?*Is this your first dog?*YesNoFirst time as an adultDo you have other pets in the home?*YesNoPlease list species breed and age of other pets:Specific breedsAges Do you already have a veterinarian?YesNoWhat is your veterinarian's name? Home DetailsPlease tell us a little about where your service dog will live, we know circumstances change.Type of housing*ApartmentCondoSingle Family ResidenceOtherDo you*Own this homeRent this homeRent-to-OwnStaying with familyDo you have a fenced yard?*YesNoNot yet, but we're getting oneNo, but we have a dog play areaHow high is the fence?*3 feet4 feet5 feet6 feetOver 6 feetIs this animal intended as a service animal for a veteran of the US Military?*YesNoDoes anyone in the home have allergies to dogs?*Yes, we have concerns & that's why we're seeking a poodleYes, but only mild to moderateNo, not that we knowWill your puppy be an inside or outside dog?*Mostly IndoorsMostly OutdoorsBothHow many hours will the dog be left alone (without a potty break) each day?*Less than 44 to 9 hours9 to 12 hoursMore than 12 hoursHave you or any one in the puppy’s future household ever been arrested, charged or convicted for animal cruelty or animal hoarding?*No way, José!Yes, but it was a minor conviction and progress has been madeYesI check records for each adult in your household.Dogs, especially service animals working in public, require grooming and it can cost up to $100+ each time if you don't do it yourself. Are you committed to this necessary expense?*YesOuch, we'll make it workI need to think about thisDo you agree to give us follow-up reports and photos from time to time?*SureNoDo you agree to return the dog to us in the case that you need to re-home this puppy for whatever reason?*YesNo Terms and ConditionsCompleting this application is a step in the process obtaining a trained animal from K9 Kompliance for the purposes of Service Dog, ESA or trained companion. APPROVAL AND DEPOSIT: I will review applications in the order they are recieved. If your home is a good fit, I'll notify you. The deposit to reserve a dog that has not yet completed training is $1,000, the remainder is due when the dog has completed obedience and come to live with you while completing task training. If the dog is fully trained in obedience the full adoption fee is due and the dog will continue on to task training while living with you. Task training is included in the fees paid for upon taking ownership. CONTRACT: We have a contract and will not place a dog without a signed contract. We believe it's the professional thing to do to memorialize our obligations to each other on paper so there are no questions later, and for that reason it's a bit lengthy. If you have questions about specific terms, you need to contact us prior to picking up your dog. I've read this and I've:*Got it 10-4Got questions about these — please contact mePlease provide any other relevant information you feel would assist us in placing a puppy in your home:Do you have any other questions for us you’d like us to note?Your Signature*webform This iframe contains the logic required to handle Ajax powered Gravity Forms.