Handler Application

It is the mission of Cover Six Canines to assist Veterans and 1st Responders in the securing and training of service dogs at no cost to the Veteran or 1st. Responder.

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Handler Application

Full Name

Full Name

Email

Phone Number

Phone number where we can reach you

Address Line 1

Address Line 2

City

State

Zip Code

Are you a Veteran or active duty?

Yes
No

If you are a Veteran which branch?

Are or were you a First Responder?

Yes
No

If you are or were a First Responder which type?

Do you have or can you obtain proof of service such as DD214 or letter from agency?

Yes
No

Has a doctor diagnosed you with disability?

Yes
No

What are your disability(s)?

Has or will a doctor write a letter stating that you would benefit from a Service Dog?

Yes
No

Do you currently have a dog?

Yes
No

If you plan on using this dog, what is the age and breed?

If you don't have a dog what breeds would you prefer?

Would you prefer a puppy or an adult?

Puppy
Adult
Doesn't matter

Who lives with you?

Do you work? Full or part time?

Full Time
Part Time
Don't Work

Have you previously trained with any other organization? If so who?