Apply for a Service Dog at Putnam Service Dogs

Putnam Service Dogs provides free Service Dogs and follow-up support to people with physical
disabilities other than blindness for residents of the United States.

We foster the nurturing bond between humans and dogs, and treat dogs humanely and
respectfully during their raising and training. We expect our recipients, their families, friends, caregivers, etc. to treat our Service Dogs as they would any treasured friend. A lot has gone into creating our Service Dogs. Graduated Service Dogs are a rare, precious gift as not many dogs have the necessary temperament and intelligence.

During our application process, your training period with your dog and our follow-up support, we will ensure the safety and humane treatment of our Service Dogs. Our Service Dogs remain our dogs, even when placed with their recipients.

We will take our Service Dog back at any sign of neglect or cruelty. We will not allow our Service Dogs to pull wheelchairs, or function as a brace. These activities can harm our dogs.

If you are wheelchair bound, or become so while living with our Service Dog, we expect you will get a power wheelchair if you can’t propel a manual one yourself. We expect you will use some method other than our dog to assist you as a brace.

We give you the huge gift of one of our Service Dogs, and we expect you to treat the dog with reverence.

Our Service Dogs are not trained to perform guide work for the blind, to respond aggressively or provide personal protection, or to assist with the management of mental illness as a primary
condition.

We will begin graduating Service Dogs in 2018. Each dog will be individually trained to perform
tasks to assist a recipient on our waiting list. Please complete the following application so help
us assess your needs. All * must be completed for the form to submit. Applying does not guarantee you will receive a dog.

APPLY BELOW
(If you are applying for a Facility Dog, please click here)

Your Name and Address
Salutation* :
Under 21 or incapable of competently caring for a dog?* YesNo If no, please add custodial parent or guardian contact info.
Custodial Information
Salutation :
I approve all communications going to both me and my guardian.
Additional Contact Information
Would you like to add an additional contact? YesNo If yes, please add below.
Salutation:
About You
Do you require a Hearing Alert Dog?* YesNo
Do you require a Seizure Alert Dog?* YesNo
Do you require a Hypoallergenic Dog?* YesNo
Are your living arrangements conducive to caring for a Service Dog?* YesNo
Explanation:
Do you have a support system (family and/or friends) to assist with transitioning to life with our Service Dog and with the responsibilities of owning a dog?* YesNo
Explanation:
A Service Dog will cost $900+/year to feed and provide vet care. Can you afford this?* YesNo
Explanation:
Will the applicant (and Parent/Guardian/Caretaker if relevant) be able to attend a 12 day training session in Putnam County, NY? You will be responsible for room and board during this period with some assistance from us.* YesNo
Explanation:
Your Personal Information
Your Birth date :
Your Height : " ' (Feet/Inches)
Your Weight :
Marital Status : SingleMarriedWidowed/WidowerDivorced
Who else lives with you? (People and animals)*
Note: If you have a dog(s) at home, we require that you find another home for your dog(s) prior to receiving our Service Dog. Our Service Dog needs to focus only on you. This is a condition of receiving one of our Service Dogs. If you have a cat(s), you can keep it (them).
Type of Home you live in* : ApartmentHouseOther
Fenced Yard?* : YesNo

Type of Area you live in* : UrbanSuburbanRuralOther
Explanation:
Type of Area you and your Service Dog will visit frequently* : UrbanSuburbanRuralOther
Explanation:
List any Medical Condition(s)* :
Please enter none if no conditions exist.
Disabled?* : YesNo
If Yes, How long have you been disabled?
How does your disability affect your life and current level of independence?:
List the type of activities you want your Service Dog to assist you with
Retrieve and deliver dropped items?* : YesNo
Fetch Items?* : YesNo
Explanation:
Turn lights on and off?* : YesNo
Assist you in dressing?* : YesNo
Assist you in doing the laundry?* : YesNo
Go for help in case of an emergency?* : YesNo
Open doors?* : YesNo

Open drawers?* : YesNo
Press elevator buttons?* : YesNo
Accompany you in crowded situations?* : YesNo
Explanation:
What other activities were you hoping your Service Dog would perform?
Name of person completing this form and contact information (Phone and email)
Salutation*: