Application for Service Dog

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4Gold Service and Rescue is currently accepting applications for puppies and dogs to be awarded in 2023 and beyond.

Note: These pups do not come pre-trained for service tasks . They come with a $2,500 renewable scholarship payable to a credentialed professional trainer of your choice. If you need help selecting a trainer we can aid you in that process. The scholarships are attached to the puppies or dogs from our program; we do not award scholarships to train dogs that are not from our program.

Definitions:
Applicant - Person who will be utilizing the services of the service dog.
Caregiver - Person who will be the primary caregiver for the dog (may be the same as the applicant).
Guardian - Person who has legal guardianship of the applicant if the applicant is under 18, or has been appointed by the court to be responsible for the applicant's welfare.

Email *

Name of Applicant *

Name of Guardian (if applicable)

Email Address *

Address (street/ unit #, city, state, zip) *

Phone Number *

What types of assistance do you need from a service dog? (Note: We do not currently provide emotional support or therapy dogs.) *

Diabetes Alert

Seizure Alert

Task Assistance

Mobility Assistance

Other:

In 500 words or less, describe the special needs of the applicant and what specific tasks you need a service dog to perform. *

Questions About the Home

How many people live in the home and what are their ages? *

Do any members of the household have allergies to dogs? *

Yes

Are all members of the household agreeable to having a dog in the home? *

Yes

Is the home owned or rented? *

Owned

Rented

If rented, may we speak to the landlord to assess their understanding of service animal laws?

Yes

Maybe

Clear selection

Does the home have a completely fenced in yard? *

Yes

Please describe what a typical day would be like for a service dog in your home. Will the dog be with the applicant 24 hours a day? Will the dog go to a school or place of employment with the applicant? Who will take care of the dog's needs throughout the day? Will the dog spend time alone or in a crate during the day, and if so, how long? *

Questions About Caring for the Dog

Have you ever owned a dog before? *

Yes

If so, what breeds and for how long?

Have you ever had to re-home a dog or relinquish one to a shelter? *

Yes

If so, please describe the circumstances.

Are you aware that Golden Retrievers shed and are prone to digging?

Yes

Clear selection

Will the dog sleep indoors or outside? *

Inside

Outside in a kennel

In an outbuilding such as a shed or garage

Other:

What is the primary neighborhood environment? *

Big city with a lot of noise and traffic

Suburb with neighborhood traffic

Rural with minimal traffic

Other:

Are you financially able to provide proper nutrition and veterinary care for a dog? While we understand the costs of training a service dog are prohibitive to many who need them, and we would like to help with those training costs, the cost for providing proper nutrition and veterinary care is the responsibility of the applicant and/or caregiver, and these expenses can be $1,000 or more per year depending on where you live. *

Yes

Maybe

Would you be willing to share proof of income? *

Yes

Maybe

Would you be willing/ able to share a short video introduction and tour of your home? *

Yes

Maybe

Questions About the Dog You Desire

The puppies we currently offer are Golden Retrievers or Standard Poodles. Do you have a preference for which breed you would rather have?

Golden Retriever

Standard Poodle

Either

Clear selection

Are you looking for a puppy, or an adult that is already fully trained?

Puppy (younger than 12 weeks)

Older pup or adult with some basic obedience training.

Fully trained adult dog (Note: 4Gold does not provide fully trained dogs. We provide the first two options only, along with a scholarship for training. If you need a fully trained dog then you may need to apply elsewhere.)

Other:

Clear selection

Would you prefer a male or a female?

Female

Male

Either

Clear selection

Do you have a preference for a dog rescued from a shelter, or a dog bred specifically for service?

I would be receptive to a shelter dog

I would prefer a dog specifically bred for service

Clear selection

How soon are you wanting to take possession of a dog or puppy?

Less than 6 months

6-12 months

12-24 months

Longer than 24 months

Clear selection

Have you already selected a credentialed service dog trainer? If so, please provide their name and contact information. *

Would you be able to pick up your service dog in Northern Utah, or would you need it to be delivered to you? *

Pickup

Delivered

Once an award is made, recipient is expected to take possession of the puppy/dog as soon as possible to begin bonding and becoming part of the family. Do you understand that we will not continue housing and training the dog for you at the 4Gold facility? Exceptions may be made if the puppy is enrolled in obedience classes that need to be completed.

Yes

Other:

Clear selection

If awarded a service dog, you would be required to sign the attached agreement. Do you accept the conditions of this agreement? *

Yes

Maybe

Send me a copy of my responses.

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