Paws of War Service Dog Application

THIS APPLICATION IS FOR VETERANS, FIRST RESPONDERS AND GOLD STAR FAMILY'S ONLY.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Mobile Phone Number *

Home Phone Number *

Email Address *

Marital Status *

Single

Married

Widowed

Divorced

Sex *

Male

Female

Age *

Children *

If yes, please list their names and ages:

What is your Facebook account name? *

What is your Instagram account handle? *

What is your Tik Tok account handle? *

Place of employment *

Annual Household Income *

Will you be moving or relocating in the near future? If so, when and where? *

Are you a United States military veteran, active military, or a first responder? *

Veteran with Honorable Discharge

Veteran with Dishonorable Discharge

Veteran General Discharge under Honorable Conditions

Active Duty Military

First Responder

Branch of Service *

Years Served (If still serving, enter start date) *

Campaign *

Have you ever been convicted of a NJP, Court-Martial, Or Felony? *

Yes NJP

Yes Court-Martial

Yes Felony

None Of The Above

Please provide your social media links: Facebook, Instagram, LinkedIn, and/or Twitter *

Please Upload Your DD214

If you dont have access to your file electronically, please mail a copy to Paws of War, 127-6 Smithtown Blvd.
Nesconset, New York 11767

Medical History

Do you have: *

Please list all other current disabilities, physical limitations, medical conditions or injuries and provide a description of each: *

Do you use any equipment that your service dog would have to become accustomed to? (Such as a wheelchair, cane, etc.) *

If yes, what type of equipment?

Do you have a legal caregiver? *

If yes, how many hours a day?

Doctor's Name *

Doctor's Last Name *

Doctor's Street Address *

Address Line 2

City *

State *

Zip Code *

Doctor's Phone Number *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Street Address *

Address Line 2

City *

State *

Zip Code *

Emergency Contact Phone Number *