Lila's Friends NFP

info@lilasfriendsnfp.org

Application

Application

Lila’s Friends Service Dog Program Application

Thank you for your interest in Lila’s Friends Service Dog Program. Please complete this application thoroughly and honestly to help us assess your suitability for adopting and caring for a service dog from our program. Your responses will be treated with the utmost confidentiality.

Childs Full Name

Address Line 1

Address Line 2

City

State

Zip Code

Country

Date of Birth

Phone Number

Parents Full Name

Address Line 1

Address Line 2

City

State

Zip Code

Country

Date of Birth

Phone Number

Parents Military Status

Years of Service

Branch of Service

Number of Household Members

Other Pets in the Home

Do all household members agree to having a service dog?

Ages of Children in Home

Types and ages of Animals in home (if applicable)

Primary Medical Condition Requiring a Service Dog:

Additional Medical Conditions:

Have You Spoken with Your Medical Provider About the Possibility of a Service Dog?

Are you able Provide a Signed Medical Statement from Your Provider?

**Service dogs provide valuable assistance and support for individuals with disabilities, but they do not replace medication, medical treatment, or professional healthcare. It is important to continue following all prescribed medical care and therapies alongside the support provided by a service dog.

Please Briefly Describe How You Feel a Service Dog Will Assist You:

Do you understand that even a fully trained service dog requires to keep up with their training? So you will need to keep practicing their skills

Are you prepared to adopt and care for a Service Dog?

Prior to completing this program, you will be required to attend a one-week training session in Illinois with the staff of Lila’s Friends before bringing your dog home. All travel and lodging expenses will be your responsibility. Do you agree to this requirement?

Do you understand that at no time are you permitted to rehome, transfer, or sell a Lila’s Friends dog? If you are no longer able to care for the dog, you are required to contact Lila’s Friends immediately to discuss next steps.

Have you ever owned a dog before?

If Yes, Please provide details (breed, training experience, etc):

After receiving your service dog, you will be required to complete regular check-ins with Lila’s Friends to ensure continued success and support. These check-ins will occur quarterly during the first year, every six months during the second year, and annually from years three through five. Do you agree to this schedule?

Any service dog provided by Lila’s Friends will be formally adopted to the child it is intended to assist. This ensures the dog remains with and bonded to the child they are trained to support. Do you agree and understand?

At Lila’s Friends, we prioritize matching each applicant with a dog based on specific needs rather than breed. However, if you have any preferences for a particular breed or size, please let us know so we can consider them when possible. (Please specify):

Do you live in a house or apartment?

Do you have a fenced in yard?

Do you rent or own?

How often will the dog be left at home alone if they do not attend school with the child? How many hours a day?

**If you rent, you must ensure that your landlord is provided with all required ADA documentation stating that a service dog will reside in your home. Letter of Disability and Need: A letter from a licensed healthcare professional (such as a doctor, psychologist, or therapist) stating that the tenant has a disability and requires the service dog to assist with specific tasks or functions related to their disability. This letter should not disclose the tenant’s specific medical condition unless necessary.

**All of our dogs at Lila’s Friends are kennel trained to promote their safety, security, and well-being. Kenneling provides a safe space for dogs to rest and reduces anxiety, helps prevent destructive behavior, and aids in house training, making it an essential tool for responsible dog ownership.

Are you able to provide regular veterinary care, proper nutrition, and exercise for the dog?

Do you already have a Veterinarian you go to? If so please provide their information

**At Lila’s Friends, we feed all of our dogs Purina Pro Plan to ensure they receive high-quality nutrition.

**Below are vaccines that are required and recommended for Lila’s Friends service dogs.

Core Vaccinations:

1. Rabies: Required by law in most places, this vaccine protects against rabies, a fatal disease transmissible to humans.

2. Distemper, Adenovirus (Hepatitis), and Parvovirus (DHPP/DAPP): A combination vaccine that protects against three highly contagious and potentially fatal diseases: canine distemper, adenovirus (which causes hepatitis), and parvovirus.

Non-Core (Optional but Highly Recommended) Vaccinations:

1. Bordetella Bronchiseptica (Kennel Cough): Highly recommended for dogs that interact with other dogs frequently, such as in public places, parks, or training classes.

2. Leptospirosis: This vaccine protects against a bacterial infection that can spread through contaminated water or soil and is transmissible to humans. It’s often recommended for dogs in areas with high exposure risk.

3. Lyme Disease: Recommended for dogs in regions where ticks carrying Lyme disease are prevalent.

Other Considerations:

• Heartworm Prevention: While not a vaccination, heartworm prevention medication is crucial for dogs exposed to mosquitoes, especially in certain regions.

• Flea and Tick Prevention: Regular flea and tick prevention is also recommended for dogs in public places to prevent infestation and transmission of diseases.

Reference First Name

Last Name

Relationship to you

Phone Number

Address Line 1

Address Line 2

City

State

Zip Code

Country

Reference First Name

Last Name

Relationship to you

Phone Number

Address Line 1

Address Line 2

City

State

Zip Code

Country

Reference First Name

Last Name

Relationship to you

Phone Number

Address Line 1

Address Line 2

City

State

Zip Code

Country

Please submit the following documents after submitting this application:

A copy of a valid state-issued ID
Currently Serving: Please submit one of the following
1. DEERS Verification or MilConnect Screenshot (log into MilConnect and download proof of service document.) 2. Active duty orders showing the start and end date of current assignment. 3. A commanding officer or personnel office can write a letter on official letterhead verifying that the parent is on active duty.
Veterans: A copy of the parent’s DD214 (please black out the Social Security number)
A letter from the child’s medical provider stating they recommend or support the child receiving a service dog.

Email all documents to: [sarah@lilasfriendsnfp.org]

Statement of Understanding

By signing below, I acknowledge that all the information provided is accurate to the best of my knowledge. I agree to adhere to the requirements set by Lila’s Friends and commit to providing a safe, loving, and supportive environment for the service dog adopted through this program. I also understand that I am required to familiarize myself with the ADA laws regarding service dogs to fully understand my rights and responsibilities, enabling me to effectively advocate for both myself and my dog.

Applicant First Name

Last Name