Lana’s Legacy Assistance Dog Application

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Thank you for your interest in the Lana’s Legacy Assistance Dogs Program. Our mission is to transform rescue dogs into highly trained service, therapy, facility or emotional support dogs. By filling out this application, you’re taking the first step toward receiving a well-trained companion tailored to meet your unique needs.

Please note: Submitting this application does not guarantee placement with a dog, as we carefully evaluate each applicant to ensure the best match for both the dog and the individual.

First and Last Name *

E-mail *

Phone Number *

Street Address *

How do you prefer to be contacted? *

Phone Call

Text Message

Are you a minor, under guardianship, conservatorship or a ward of the court?
*

Yes

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