Veteran Application (new) – Patriot K9s of Wisconsin

First Name

Last Name

Email Address

Confirm Email

Date of Birth

Marital Status

Spouses Name (If applicable)

Occupation

Street Address

Street Address Line 2

City

State

Zip Code

Phone Number

Backup Phone

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship to you

Emergency Contact Email

Confirm Emergency Contact Email

Are you currently a defendant in an ongoing court case?

Yes

This helps us identify candidates who fit the mission of this program please be advised that a background check will be run on the day of the first interview.

Have you even been convicted of of felony? *

Yes

Wars/Conflicts in Which You've Fought

Branch of Armed Service

Type of Discharge

Rank

Can You Provide Proof of Military Service

Yes

Must have DD214 long form

Can You Provide Proof of Service-Related PTSD, TBI or MST Diagnosis?

Yes

Must have letter from Physician/Counselor or VA stating diagnosis of service-related PTSD or TBI. Also, must provide letter from Physician/Counselor or VA stating you are medically, mentally and physically able to handle the responsibilities of owning a dog.

You must understand and agree to the following Terms of Use to be eligible to participate in the Patriot K9s of Wisconsin Service Dog Training Program. I understand if I do not attend my assigned classes with my dog (with the exception of injury or illness), I will be removed from the program. If the dog was donated to me by Patriot K9s of Wisconsin, it will be returned to the program as well.

I understand that not every dog will turn out to be a service dog even after many weeks of training. If the dog does not do well with the training or temperament issues begin to arise, the dog will not be able to continue with the program. *

I understand that if, for any reason, I am unable to keep the dog that has been donated to me by Patriot K9s of Wisconsin, the dog will be returned to the Patriot K9s program to help another Veteran.

I understand that a background check will be done to ensure no charges of domestic violence or animal abuse have been filed.

If the Service Animal candidate or it’s associated veteran is removed from the program for any reason, all training equipment as well as the dog will be returned to the Patriot K9s of Wisconsin program to be used by a different Service Animal team.

I understand that enrollment in the Patriot K9s of Wisconsin Service Dog Training Program cannot be completed until I have provided all of the required documentation. I also understand it is my responsibility to have the required paperwork with me at the time of my interview otherwise, Patriot K9s of Wisconsin will have to re-schedule my interview for a later date and time.

I give my permission to Patriot K9s of Wisconsin to use my picture for their website, Facebook and other program advertisements.