Hearing Dogs - The Sam Simon Foundation - Saving the Lives of Dogs, to Enrich the Lives of People

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CAREER CHANGE DOGS - ONLINE APPLICATION FORM

Please understand that dogs are categorized as 'Career Change Dogs' because they are not suited to complete the Hearing Dog Training Program. This can be for a variety of reasons and we are happy to discuss why a particular dog did not complete the program with you.

NOTE: *All Fields Required!

Name:
Street Address:
City:
State:
Zip:
Evening Phone:
Day Phone:
Cell Phone:
Email Address:

Do you rent or own your residence? Own Rent

If you rent, please give us your Landlord's name and phone number:

Do you have your Landlord's permission to have a dog? Yes No

Are there size restrictions for dogs in your apartment? Yes No

If there are, what are the restrictions?

How long have you lived in your present home?

Please give a description of your home and yard. (size of yard, is it fenced?)

Please list all members of your family and their ages.

Do you have regular visitors to your home? Yes No

If so, please list approx. ages.

Please list all pets currently in your home, both inside and outside.

Please tell us why you are interested in adopting a dog?

Please describe or name the dog you would LIKE to adopt.

Is there any size or type of dog you DO NOT want?

Would you consider adopting an older, senior dog? Yes No

My dog needs to be able to be home alone (per day) (please select one )

2 hours or less 4 hours or less 4-8 hours 8-10 hours 12 hours

How many days in a week will the dog be home alone?

When I am not home, my dog will spend his time in….(please select one)

the garage a crate the yard loose in house confined to one room

Other:

If you have had a dog in the past, what happened to it?

My dog needs to get along with other dogs Yes No

My dog will primarily be an… Indoor dog Outdoor dog

If you have children in your home, are they familiar with dogs or have they been around dogs before?

Have you discussed adopting a dog with all members of your family? Yes No

Have you had dogs before? Yes No

Are you interested in adopting a dog as soon as possible? If not, please explain:

What kinds of activities are you planning to include your dog in?

I am comfortable doing some training with my dog to improve manners such as jumping, stealing food and pulling on the leash.

I am financially able to take care of a dog. Yes No

How did you hear about our Career Change Dogs?

How many hours do you work away from home?

We are a 501 C3 non-profit organization privately funded through the generosity of Mr. Sam Simon so we do not accept any public donations.
WE OFFER THESE SERVICES FREE OF COST TO ALL RECIPIENTS OF OUR PROGRAMS.

The Sam Simon Charitable Foundation.

info@samsimonfoundation.org

310.457.5898 VoiceTTY