FSD Therapy Dog Application

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Before filling out the application, we ask that you thoroughly review our website, particularly the "Service Dog FAQ", the criteria listed on the "Apply For A Service Dog" page, and the "Application Check List" to ensure that you qualify for our program. Freedom Service Dogs of America (FSD) serves several specific client types, and we unable to serve you if your needs are outside our predefined range of clientele. FSD does not discriminate on the basis of race, color, creed, national origin, sex, age, religion, marital status, sexual orientation, gender identity or expression, veteran status, HIV/AIDS status, physical or mental disability.


Saving Your Progress

You will likely need to complete the application in two or more sessions. To ensure your application and information are not lost, we strongly recommend that you utilize the "Save Progress and Return Later" feature, found in the upper right corner of the webpage. Please remember the password you set when using this feature, and check your email for a link that will allow you to open your partially completed application and resume your progress. If your application remains in progress and uncompleted for more than a year, it will be deleted and you will need to start a new application. 



Application Instructions

Expect the application completion process to take between 1 - 2 hours. During the completion of this application, you will be required download and upload files, and to print or email documents to your references. We strive to make the experience as user friendly as possible, but we encourage you to seek technological support from family or friends if you feel the need to do so.

  

In order to complete the application, you will be responsible for providing, identifying, and/or obtaining the following:

  • One completed Professional Letter of Recommendation form, filled out and signed by a supervisor or direct co-worker
  • One completed Veterinary Letter of Recommendation form, filled out and signed by the vet you will be bringing your therapy dog to for routine care
  • Vaccination records for any pets in your home
  • Documentation of your experience in Animal Assisted Therapy

If you have any questions about your eligibility for the Freedom Service Dogs program or filling out the FSD application, please contact us at: 303.922.6231. You are also welcome to visit the FSD website at  www.FreedomServiceDogs.org.

Please Note: Therapy Dogs require a $2,500 fee, payable upon acceptance to our program.

Name












Current Address







Permanent Address








Demographic Information
We are gathering important demographic information to track progress on inclusivity and diversity measures being taken within our organization. To the extent you are comfortable, please select the options that best reflect how you identify.









Hidden Fields



Therapy Dog Program Application


























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People in the Home
List the people living in your home. Select to 'add another' and fill in the details for each individual.
Age Above 18




Age Under 18




Safety Plan
Please identify the individual who would serve as a potential backup or "emergency" support person for the therapy dog in case of an emergency or other unforeseen circumstance.
Emergency Support Person Details






Secondary Handler
Please identify the individual who would serve as a secondary handler for the therapy dog in your workplace if you must attend to other work responsibilities. Note, the secondary handler is not responsible for financially supporting or housing the therapy dog.
Secondary Handler Details






Professional Therapy Dog Program
















Living with a FSD Therapy Dog

Do you agree to the following conditions?

















FSD requires that new therapy dog teams submit monthly reports for the first year after they graduate. These forms are submitted online and contain a variety of questions about the dog's ongoing health and behavior. Once the first year of the match is complete, and every year after that until the dog's retirement, you will be required to submit an annual report that includes your dog's vet records and behavioral notes.





Instructions: To enter your signature below to authorize release of liability and indemnification, first type your name in the Name field. 

Sign below if you agree to the conditions to living with a therapy dog listed above.


References

Freedom Service Dogs requires two references: one from your veterinarian and one for a professional or personal colleague who is not related.  Please list the names and contact information for your references and upload two letters of recommendations. 
Reference 1: Veterinarian

Current Veterinarian










If you are currently using a veterinarian for your pets, or have an ongoing connection to a veterinarian that cared for former pets, you are required to have that individual complete the Veterinary Reference Form. Please download it here, provide it to your vet, and upload the completed version below.

Instructions: To enter your signature below to authorize release of liability and indemnification, first type your name in the Name field. 


I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to Freedom Service Dogs.

Reference 2: Professional




You are required to upload the Letter of Recommendation from your professional reference. Please download the Letter of Recommendation form and provide it to your professional reference before uploading below.

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Contact Information