Thank You for Your Interest In our Assistance Dog Training

Please Complete the Application Below and We'll Be in Touch

Full Name *

Email *

Phone *

Address

How did you hear about Canine Interaction

Google
Social Media
Family / Friend
Other Website
Vet / Groomer
Another Trainer
Other
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Dog's Name *

Dog's Age *

Dog Breed/s *

Vaccination Record

Medical conditions can impact a dogs ability to work. If accepted into the program your dog will need to see a vet for clearance to participate.

Does your dog have any medical conditions? When did they last see the vet?

Is your dog up to date with Parasite control? Heart worm, fleas, worms, ticks etc

Yes

No

Select all behaviours your dog is/has exhibited

Resource Guarding

Handling Aggression

Reactive to Strangers

Aggression / Intimidation of family members

Reactive to other dogs when on lead

Reactive to other dogs when off lead

Aggressive / Chasing other animals eg cats

Barking

Destruction

House Soiling

Impulse Control

Separation Anxiety

Has your dog completed any formal training

Puppy Preschool
Pet Dog training / Obedience
Competition Experience
NIL
Other
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How long has the dog been in your home?

Please help our trainer understand how your disability impacts your life and how having a service dog would make a difference for you.

What behaviours would you find most beneficial in your home

What behaviours would you find the most beneficial in public spaces/around other people?

Do you anticipate any changes in your disability that would require additional task training for your potential service dog?

Help our trainers to understand if dog training lessons and techniques need to be accommodated to meet your needs. Dog training often involves the following: Select those you may have difficulty with

Listening to Trainer

Participating in 1 hour session

Watching Demos

Remembering Instructions

Bending / Crouching / Sitting to work the dog

Walking with the dog

Pressing the Clicker

Holding the Lead

Putting equipment on/off the dog

Handling treats - physically or sensory

Going to different locations

Picking up after dog

N/A

Other

If yes, can you please explain the difficulties

Do you have support from your licenced health care professional?

Yes

No

How would you describe your dog? E.g. Happy, nervous, excitable etc

What do you do with your dog for fun?

What are your goals for the dog during your training?

Additional Information you would like to share

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