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:

Have you or will you sell or give a dog away for laboratory experimentation? Yes No

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 the type of dog you would LIKE to adopt.

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

How often and for how many hours a day will the dog be left alone?

Where will the dog be kept when it is alone?

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

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

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

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