Paws’itive Teams
Voice:(858) 674-0845
Fax:(858) 674-7461
paws@pawsteams.org
San Diego, CA

Your donation can help change lives!

Pre Application for Service Dog Placement

If you feel you would qualify for a service dog and would like additional information, complete the following pre-application form.

This is not a formal application. It is an inquiry so we can learn more about potential applicants. We do not require formal applications until we feel we have an appropriate dog. Inquiries are kept in our files for future matching. Potential applicants are screened to determine individual needs and the ability to benefit from a service dog and to provide a safe and healthy living environment for the dog. Please Note: only those living in San Diego County will be considered.

Personal Information
Do you live in San Diego County? If no, do not proceed as our placements are limited to persons living in San Diego County.

Yes

First Name:

Last Name:

Street Address:

City and Zip:

Telephone:

Date of Birth:

Occupation:

E-Mail Address:

Verify E-Mail Address:

Website Address (if applicable:)

If person is a minor, please list name of parent or guardian:

Gender:
Male Female

Residence/Lifestyle Information
Are you or other members living in your household allergic to animals? Please explain:

Describe other members in your home. Do you have an attendant?:

Select your home type:

Select your yard type:

Describe your home life, social activities, hobbies and lifestyle in general. Do you work or travel or go to school or volunteer?

Describe a typical day in your life:

Do you use special equipment or assistive technology? (i.e. cane, wheelchair, van with lift, walker, braces, speech board, other devices) If yes, please explain:

How do you get around town? (i.e. van, own car, public transportation, friends) Please elaborate.:

Background Information
How did you hear about Paws’itive Teams?:

Please describe your disability and the nature of your physical limitations:

Please describe the various ways you feel a service dog could benefit you:

Describe prior experiences with dogs in your life. Do you currently have other animals living in your home?:

Have you ever been partnered with a service dog? Please give details:

Have you applied to another service dog program? If so, how long ago?:

If you had to go into the hospital or became very ill, who would take care of your dog?:

Please retype this code below :

After completing the entire form, click on the SUBMIT button below. You will receive confirmation via e-mail.