Facility Dog Application

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Application to Receive a Facility Dog

Please read the general information and requirements for placement of a facility dog on our website. If you have remaining questions, please send an email to hero@hero-dogs.org. You will automatically receive an emailed copy of your completed application for your records.

This application should be completed by the facility staff member who will take primary responsibility for the dog and ultimately assume ownership of the dog. Please note that we are not able to predict how long it might be before a dog is available that suits your needs, and we recommend also applying at other organizations.

Your First Name *

Your Last Name *

Email *

Work Phone *

Mobile Phone *

Occupation/Title *

Facility Information

Please select the category into which your facility fits. *

Organizations who identify as primarily veteran-serving, first responders, or active-duty military (e.g. fire departments, law enforcement agencies, specialized rehabilitation centers)

Clinicians who specialize in veterans, first responders, or active-duty military (e.g. private practice therapists, mental health organizations, physical therapists)

Organizations that work in crisis response or trauma recovery (e.g. child advocacy centers, victim services organizations)

Facility Name *

Street *

City *

State/Province *

Zip *

Web Site

Please describe the type of facility: *

Do you agree to provide written authorization from whoever holds ultimate authority over this process at your facility? *

Yes

Please tell us why you are interested in obtaining a facility dog from Hero Dogs. What role(s) do you envision for the dog at your facility? *

Please give your typical work hours (e.g., M,T,Th 8am-5pm; W 2pm-9pm; Sa 7am-3pm) *

Are there any days/times when you would NOT plan to take the dog to work with you? *

Yes

If yes, please explain further.

I understand that when I am not working, the dog will live in my home, not at the facility. *

Yes

Please describe the accommodations you have planned for the dog at the facility. Where will they crate be kept? Where will they be fed and given water? Where will they be taken to eliminate? *

Please describe what you envision as a typical "workday" from the dog's perspective. Include times, activities, and staff member responsible. For example:

8 am - 10 am: Visit with residents in activity room (John S.)
10 am - 11 am: Physical therapy (Lisa M. or Sara R.)
11:00 am - 12:30 pm: Counseling sessions in my office (myself)
12:30 pm - 1:00 pm: Outdoors for elimination/walk (myself)
1:00 pm - 2:00 pm: My office while I do patient notes (myself)
2:00 pm - 3:30 pm: Various activities in activity room (John S.)
3:30 pm - 4:30 pm: Outdoor recreation activities (Kyle P.)

"Typical" daily routine: *

The dog you would be adopting will be young (~2 years old). These dogs require adequate daily exercise. Please describe when, where, and how you will exercise the dog. *

Has your facility ever had a facility dog before? *

Yes

Do therapy dogs also visit your facility? *

Yes

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Home Environment

Address Line 1 *

City *

State/Province *

Zip/Postal Code *

Home Phone

Which best describes the area in which you live? *

What type of home do you live in? *

Do you rent or own your home? (NOTE: If rented, a copy of lease or written permission from landlord will be required.) *

Own

Rent

Do you have a fenced yard? *

If yes, please describe (height of fence, size of enclosed area).

What is the maximum number of hours the dog would ever be left at home alone (i.e., no humans)? *

Please describe where the dog will be kept when at home alone. *

Please describe where the dog will sleep at night. *

Do you have suitable transportation, for example to take the dog to work with you or to the veterinarian? Please note that our facility is not accessible via public transportation, and facility dogs do not have public access rights. *

Yes

Household Members

List all the members of your household, their relationship to you (spouse, child, etc.), occupation, and the hours that person is away from home on a typical weekday (e.g., 8 a.m. - 4:30 p.m.). Please give ages of children.

EXAMPLES:

John Smith, spouse, auto mechanic, at work from 7:00 a.m. - 6:00 p.m.

Peter Smith, son, age 9, in school from 8:30 a.m. - 3:30 p.m.

Judy Smith, daughter, age 3, daycare 8:00 a.m. - 4:00 p.m.

Person #1

Person #2

Person #3

Person #4

Person #5

Person #6

Is everyone in the household excited and in agreement about adopting a dog? *

Yes

If no, please explain.

Is anyone in the household allergic to dogs? *

Yes

Is anyone in the household afraid of dogs? *

Yes

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Other Household Pets

Please list all pets currently in the household. To be eligible or a Hero Dog, you must have no more than four pets (cat or dog) living with you. No more than two of these pets may be dogs.

Pet #1 Name

Species

Breed

Gender

Age

Pet #2 Name

Species

Breed

Gender

Age

Pet #3 Name

Species

Breed

Gender

Age

Pet #4 Name

Species

Breed

Gender

Age

If you have dogs, are they:

House dogs

Outdoor dogs

Please describe how your dogs react to people when people approach your yard/house or visit your home.

Please describe how your dogs react to people when they meet people out on a walk or away from your home.

Please describe how your dogs react to other dogs.

Have you previously owned other dogs as an adult? *

Yes

If yes, what breeds or mixes?

What became of them?

Have you ever personally obedience trained a dog? *

Yes, in group classes

Yes, with a private trainer

Yes, on my own

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References

If you currently have a veterinarian, please give his/her information below. If you do not have a veterinarian, please use another dog-related reference if possible (such as groomer, trainer, pet-sitter, etc.). Otherwise, give a non-family member personal reference.

Business name:

Contact name: *

Business phone: *

Email: *

Street: *

City: *

State: *

Zip: *

How do you know this person? *

How long have you known this person? *

Please give another (non-family member) personal reference.

Name *

Phone: *

Email: *

Street: *

City: *

State: *

Zip: *

How do you know this person? *

How long have you known this person? *

Other Information

I understand that a facility dog is NOT a service dog, and as such does not have public access rights outside my facility. I will never attempt to use the dog as a service dog. *

Yes

I understand that I will be responsible for the dog's care, health, and well-being at all times - work hours and off-work hours (nights, weekends, holidays, etc.). The dog will travel to and from work with me and reside with me when I am not at work. *

Yes

I understand that I will be responsible for maintaining the dog's skills and behavior, and that continued training with the dog will be necessary. *

Yes

I understand that I will be financially responsible for the care of the dog, including but not limited to high-quality food, dog supplies, local licensing/registration, monthly parasite preventives, and veterinary care. *

Yes

I understand that both I and the facility will be legally responsible for the dog, and that we must carry appropriate liability insurance. *

Yes

I understand that there is a training requirement for the placement of a facility dog, and that I or the facility are responsible for the costs of transportation (and lodging if necessary) for required training at Hero Dogs. *

Yes

I understand that Hero Dogs will make visits to the facility and my home for inspection and training. *

Yes

I understand that if additional training or site visits are required or requested, Hero Dogs will charge me or the facility a fee for staff time and travel. *

Yes

I understand that I must have reliable transportation in order to attend training at the Hero Dogs facility. *

Yes

I understand that there may be an indefinite wait before I am contacted about a potential dog placement. *

Yes

Is there anything else that you think we should know when considering you to adopt a facility dog from Hero Dogs?

How did you hear about Hero Dogs, Inc.?

Thank you for your application. We will contact you after it has been reviewed.

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