PRO-TRAIN SERVICE DOG APPLICATION FORM
Pro-Train, 1544 Avohill Dr., Vista, CA 92084, Phone (760) 749-0897
NAME:
DATE:
mm/dd/yyyy
ADDRESS:
CITY:
STATE:
ZIP:
E-MAIL ADDRESS:
DATE OF BIRTH :
mm/dd/yyyy
TELEPHONE DAY:
TELEPHONE EVENING:
xxx-xxx-xxxx
EMPLOYMENT INFORMATION:
Current Employer:
Occupation:
Address:
City:
State:
Zip:
GETTING TO KNOW YOU
Your Disability:
Your Limitations:
Have you ever had a Service Dog?
Yes
No
If "Yes" explain:
What would you like the Dog to do for you?
LIVING ARRANGEMENTS
:
What type of dwelling do you reside?
House
Apartment
Condo
Other (Please explain)
Do you
Own
Rent
Other Pets:
OTHER MEMBERS OF YOUR FAMILY:
Full Time / Part Time
Name:
Relationship:
Age
FT
PT
Name:
Relationship:
Age
FT
PT
Name:
Relationship:
Age
FT
PT