Application Form

This form must be completed and submitted in order to join Pets and People and have us help in certifying/training your own animal for Service work.

Remember that Pets and People works only with program members. This form will serve as your membership form; you do not need to complete a Membership Form separately. As a Service Animal applicant, you will NOT receive a membership card; instead, we will provide a training card for you & your Service Animal, and, after you successfully complete the Public Access Test, a certification card & Pets and People patch.

There are no waiting lists with a self-trained animal and your costs will be significantly less than if you were getting a program-trained dog. Of course, you are responsible for any and all costs for training your dog. Please take a look at the Public Access Test we require before we certify an animal.

PLEASE BE AWARE: Pets and People: Companions in Therapy and Service will only be in business until the end of 2008. If you need advocacy now or think you will be able to complete the Publc Access Test by mid-December, go ahead and apply. Otherwise, you might be better served by using our Resources for Self-Training.

If you're ready to take a step towards independence by training your own Service Animal, start the four step process by submitting the application below.

Questions in RED are REQUIRED. Your application for membership will not be accepted if they are not completed.

E-mail Address:
(not required, but a good idea in case we need to contact you)
Name (First & Last):
Street Address:
2nd Line (if needed):
City, State, Zip:
Daytime Telephone #:
Evening Telephone #:
This address is a: House Apartment
I: Rent Own

Are you employed outside the home?Yes No

If Yes, please complete the following:
Company:
Address:
2nd Line (if needed):
City, State, Zip:
Company Telephone #:

Your Job Title:
Describe your job duties. What do you do in a typical day?

Besides yourself, how many people live in your home? None 1 2 3 4 5 6 or more
List their names, ages, relationship to you:

Name of the person who would be responsible for the daily care of a Service Animal:

What breed /size is your animal?? 
What is its name?

Please list your hobbies:

Please describe a typical week for you:

Has a doctor or psychologist diagnosed your disability?YesNo
If YES, what is it?:
How would a Service Animal improve your quality of life?

What specific things would a Service Animal do for you?

If you could change one thing about your life, what would it be?

By pressing ACCEPT below, I am making application for services (that may include training help, certification, and identification) through Pets and People: Companions in Therapy & Service. I understand that Pets and People will not supply me with a Service Animal. Regardless of any service Pets and People may render, I am solely responsible for training my own Service Animal, and for any costs that may be incurred for training or maintenance of the animal. I further understand that by submitting this application, I am applying for membership in Pets and People: Companions in Therapy & Service, and that my membership fee of $40 (US) is NONREFUNDABLE.

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