Patriot PAWS In Home Working Dog Application

Date (mm/dd/yyyy)

In Home Working Dog

At Patriot PAWS Service Dogs, we strive to place Service Dogs of the highest quality with disabled Veterans. As a result of these high expectations, some of the dogs are not able to complete the program to become a Certified Service Dog. These dogs are transitioned into different capacities—some receive a “career change” and become Facility Dogs or work in law enforcement, others become In Home Working Dogs and still others become wonderful family pets. These dogs have been through some of the same, exceptional, training as all Patriot PAWS Service Dogs, but due to medical, behavioral, or temperamental reasons, they do not meet the standards for becoming a Certified Service Dog.

If you are thinking of applying one of our lovable dogs as an In Home Working Dog, please consider the following:

Patriot PAWS Service Dogs acquires dogs from a variety of sources. These include, but are not limited to: breeders, rescues, donations, and shelters. Consequently, some of our dogs are purebred while others are mixed breeds.
The dogs that are offered for In Home Working Dog placement may have some type of medical, behavioral, or temperamental problem. These issues will be disclosed to you before the placement takes place.
Upon receiving a Patriot PAWS dog, you will receive a description of the cues he/she has been taught. If you are receiving this dog as an In Home Working Dog, we ask that you plan on working with trainers for a few hours to receive the training that you need to understand how the dog could be of use to you.
We review all applications received. Dogs are paired with recipients based on the information provided in your application and on an evaluation our trainers will perform. This information will allow us to find the best match.
Patriot PAWS reserves the right to deny an applicant based on information provided to us about a potential recipient.
Dogs placed as In Home Working Dogs from Patriot PAWS are placed as companions only. The person adopting the dog agrees to assume all responsibility and liability for the dog, and will not take the dog in public as a service animal in any way or form.

If you are interested in receiving one of our dogs as an In Home Working Dog, please fill out the application. After we receive your application, you will be placed on our current list of applicants. You will receive an e-mail or phone call once a suitable match is determined. You are welcome to e-mail or call to check on the status of available dogs.

General Information

Patriot PAWS will only review completed applications. A complete application is one that includes ALL requested documentation.
Sending in an application does NOT mean you are automatically approved. Once submitted, your application will go before a committee for tentative approval.
You must be willing to facilitate an in-home visit with a Patriot PAWS representative. This may be in person or virtual.
You must provide up to date vaccination history on any current dogs and cats at your residence.
If approved, you must be willing to travel to Rockwall, Texas for training and placement. These dogs will not be allowed on flights, please keep this in mind for travel planning.
If approved, you must be willing to bring any current children and dogs with you to meet a potential placement.
Patriot PAWS considers ALL applications regardless of age, race, sexual orientation, or religion.

In order to ensure that each In Home Working Dog Team is successful, it is the policy of Patriot PAWS that if an In Home Working Dog is to be placed in a home where more than one pet is present, we reserve the right to deny placement.

Because of this policy, we encourage you to also apply with other agencies.

Please Initial: I have read and understand the above information.

Documentation

Upon submission of this application, you will receive a link to additional required documents. In order to complete your application process, you will be required to submit the following:

A copy of your DD214, or equivalent for Reserve Component Veterans (if applicable)
A Family Care Plan letter
An acknowledgement of Patriot PAWS rights to approve/deny applications and act in the best interest of any Patriot PAWS dog

Documents can be mailed to:

Patriot PAWS Service Dogs
c/o Jackie Fox
254 Ranch Trail
Rockwall, TX 75032

Faxed to:

972-772-3284

Or scanned and emailed to:

jackie@patriotpaws.org

Personal Information

Name (First Last)

Date of Birth

Street Address

City

State

Zip Code

Phone Number

Text (Y or N)

Have you served in the military?

Branch of Service:

Years of Service:

Rank (at discharge):

Medals, Awards, Honors, Tours, or anything you would allow us to include in your story:

Please tell us why you would like to receive a Patriot PAWS dog:

Do you have any experience with dogs? If yes, please explain:

Where/how did you hear about Patriot PAWS Service Dogs?

Home Environment

Where do you currently reside?

Other:

If renting your home, do you have written permission from your landlord to own a dog? You will be asked to provide proof of written permission before adoption is completed.

Please list anyone currently residing in your household: (Name, Gender, Age)

Other than the children residing in your home, will the dog be exposed to children on a regular basis? If yes, please explain:

Please list any pets currently residing in your household: (Type, Breed, Age)

Do you have a fenced in yard?

Who will be the primary care-giver of your Patriot PAWS adopted dog?

Where will your dog be kept during the day? How long will dog be alone?

Where will your dog be kept at night?

Please tell us any other information you would like us to know when considering placing a Patriot PAWS dog in your home:

Veterinarian

Do you have a veterinarian? If yes, please provide the clinic name:

Veterinarian Address:

Veterinarian Phone Number:

Media Release

Patriot PAWS Service Dogs periodically uses forms of media (i.e., photography, video, audio, footage, testimonials) for publicity, social media (Facebook, Twitter, Instagram, YouTube, Tik Tok, LinkedIn) and/or educational purposes. By signing, I acknowledge that I have received this document and give permission to Patriot PAWS Service Dogs to use my likeness (including first name, pictures, and video) in the above forms of media.

E-Signature

Date (mm/dd/yyyy)

I understand that I have the right to revoke this authorization at any time, and it must be submitted in writing to the Compliance Officer at:

Terri Stringer/HIPAA Compliance Officer

Patriot PAWS Service Dogs

254 Ranch Trail

Rockwall, TX 75032

Patriot PAWS In Home Working Dog Application

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