LifePaws Companion Dog Application

Please complete this application as thoroughly as possible so we can better understand your household, needs, and the kind of companion dog that may be the best fit.

Applicant Information Full Name Address Phone Email Occupation Spouse/Partner Name Spouse/Partner Occupation Spouse/Partner Phone Spouse/Partner Email

Household Information How many adults are in your home? How many children are in your home? Household members Current pets / animals Is anyone in your family afraid of dogs? Any dog-related allergies?

Dog Preferences Preferred coat type Preferred size Preferred color Preferred gender Activity level Explain your activity level / lifestyle

Needs & Diagnoses

Select all that apply.

Please describe needs, diagnoses, or support goals Any special needs in the family?

Experience & Commitment Have you trained a dog before? What level of training experience do you have? Have you owned a dog before? How long will the dog be home alone? Are you willing to train with your dog?

Yes No

If needed, explain Are you willing to fundraise?

Yes No

Are you willing and able to handle grooming and routine care?

Yes No

Financial & Contribution Household income Please describe your ability to contribute financially

Additional Information How did you hear about us? If for any reason you need to part with your dog, are you willing to notify us and allow us to re-home the dog or receive the new owner’s contact information? Anything else you would like us to know?

Signature Signature Date

By submitting this form, you confirm that the information provided is accurate to the best of your knowledge. Submission does not guarantee approval.

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