Applicant Services: PTSD Dog Application Stage 1
About You
Personal Information
Legal First Name
Legal Last Name
Preferred First Name
Birthdate
Gender
Male
Female
Non-Binary
Prefer Not to Disclose
Other
If other:
Pronouns
He/Him
She/Her
They/Them
Prefer Not to Disclose
Other
If other:
Please upload a photo of yourself
A full body shot with your primary assistive device (if applicable) is preferred. If there are other people in the photo please crop before loading to make clear which person is you. This photo will only be used internally.
Contact Information
Email
Phone 1
Phone 1 Type
Please select...
Home
Cell
Work
Phone 2
Phone 2 Type
Please select...
Home
Cell
Work
Street Address
Address Line 2
City
Province
Please select...
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
What is your preferred form of communication for this application process?
Note: Some steps will require Email communication. However, we strive to communicate in the indicated method(s).
Phone
Email
Text
Video Call (Facetime/Zoom or Similar)
Are you military/veteran or a First Responder in one of the following categories: Police, Paramedic or Fire?
We are not accepting applications from other individuals or classifications of first responders (due to funding restrictions) at this time.
Yes
No
Do you live in Greater Vancouver, BC; Kelowna, BC; or Calgary, AB?
Yes
No
We're sorry, you do not currently qualify for the PADS PTSD Program
PADS currently only places PTSD Service Dogs with veterans or first responders and in the regions listed above. Please visit
Assistance Dogs International
or the
Canadian Association of Guide and Assistance Dog Schools
to find another school.
Are you currently in active duty/service?
Yes
No
Please describe how you hope a PADS PTSD Service Dog will support your independence:
About Your Home
What type of home do you live in?
House (Single Family Dwelling)
House (Multi Family Dwelling)
Apartment
Townhouse
Other
If "Other", please explain:
How would you classify the neighbourhood you live in?
Urban
Suburban
Rural
Do you have a yard?
Yes
No
If yes, please provide us with more information:
Fenced
Unfenced
Acreage
Are there sidewalks in your neighbourhood?
Yes
No
Some of our dogs may occasionally alert bark in the home to someone at the door or unseen noises. Would this be a deal breaker when considering a match?
Yes
No
About Your Living Situation
In your immediate household, do you live:
Alone
With other people
How long have you lived alone?
If you do not live alone, please answer the following questions: Do you have plans to live alone soon? Are you able to live alone without assistance?
Tell us about the other members of your household. Please specify ages and their relationship to you (i.e. spouse, child, roommate, etc.). Please also note if they live with you full or part-time (i.e. children with shared custody, a partner that travels for work frequently, etc.).
Do you have any pets?
Yes
No
If yes, please describe what kind and how many pets you have:
Have you had a pet or working dog in the past?
Check any/all that apply
Yes - Pet
Yes - Working Dog
No - I've never had a pet or working dog in the past
About Your Lifestyle
Please tell us about your work
I work full-time
I work part-time
I do not work or am retired
Do you leave the home for work (please answer based on NON-Covid times)
Yes
No
Sometimes
What kind of work do you do?
Do you go to school?
Yes
No
How many hours per week do you attend school?
What type of school are you in?
High School
College/Trade School
University
Other
If "Other", please describe
Please describe your activity level:
Very Active (Daily Physical Activity - 1 hr or more)
Active (Daily Physical Activity - Less than 1 hr)
Moderately Active (Weekly Physical Activity)
Less Active (Less than once per week)
How much exercise would you be able to give an Assistance Dog on a daily basis?
Less than 30 minutes
30-60 minutes
More than 60 minutes
What ways are you able/willing to exercise an Assistance Dog?
Check any/all that apply
Hiking/Trail Walks
Neighbourhood Walks
Off-Leash Dog Parks
Swimming
Other
Are you prepared to have a Service Dog with you most or all of the time?
Yes
No
It depends
If no or it depends, please explain:
What kind of transportation do you use?
Check any/all that apply
Automobile (car/van/SUV)
Bus
Skytrain/Subway/Tram
Train
Other
How frequently do you leave the home (on average) for errands, activities, work or school?
Daily
2-3 times/week
Once/week
A few times a month
Monthly
It varies
If it varies, please explain:
What kind of activities do you participate in outside the home?
What kinds of activities do you participate in at home?
Emergency Contacts
Person 1
First Name
Last Name
Relationship to Applicant
Email
Phone
Person 2
First Name
Last Name
Relationship to Applicant
Email
Phone
PADS may use my contact information for the following purposes:
Regarding applying for an assistance dog
With general communications from PADS (upcoming events, fundraising, eNewsletter, etc.)
Contact Information