Apply to Adopt a Career Changed Dog

Contact Information

First name

Last name

Street address

City

State

Zip code

Phone number

Email address

Date of birth (mm/dd/yyyy)

Occupation

Home Information

Type of home

What type of fence do you have?

On an average day, how many hours would the dog be left home alone?

On average, how many hours would the dog be left alone at any one time?

List the name, age, and relationship to you of everyone living in the home?

Do you currently have pets in the home?

List the species, breed, sex, age, and spay/neuter status of each animal in your home:

Are all dogs/cats in your home vaccinated?

Provide the name and address of your veterinarian

Do you give permission for us to contact your veterinarian for a reference?

Experience

Why are you interested in adopting a career changed dog?

What prior experience do you have with dogs?

How did you hear about Susquehanna Service Dogs?

Reference

Please provide the name and contact information for a family member or friend not living in your home that we can reach out to as a reference for your application.

Full name

Phone number

Email address

Relationship to you

Contact Information