Operation Canine Companion Application Form

Completing the form below is the first step to be considered for an Operation Warrior Shield (OWS) Canine Companion. Additional information may be required.

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Name *

First

Last

Email *

Address *

Address (optional)

City *

State *

ZIP *

Cell Phone Number *

Emergency Contact Number *

I understand that the OWS Canine Companion Dog program is designed for Veterans/First Responders. *

• Yes
• No

Are you a military Veteran? *

• Yes
• No

Are you a First Responder? *

• Yes
• No

I am physically able to provide the necessary and adequate exercise for my dog. *

• Yes
• No

list OWS dogs

I will take full ownership of and complete responsibility for my dog. *

• Yes
• No

I will not delegate primary responsibilities including exercise, training, daily care, or decision making to any other individual. *

• Yes
• No

My living situation, schedule and family members are agreeable to having a dog. *

• Yes
• No

I am living in a stable living environment, including the financial ability to provide care for an OWS Canine Companion (including, but not limited to, food, veterinary visits, medication, etc.). *

• Yes
• No

If a conflict arises between my OWS Canine Companion and my other pets, I understand that it is my responsibility to attempt professional training of my existing animal(s). If that does not resolve the conflict(s) it is my responsibility to either re-home my other pets, or return my OWS Canine Companion to OWS. *

• Yes
• No

In the event that I am unable to personally provide care for my OWS Canine Companion, I agree to notify OWS to discuss future options for my OWS Canine Companion. *

• Yes
• No

Are there existing dogs in your household? Please note: OWS limits the number of dogs in a household to 3 dogs (1 OWS Canine Companion + 2 personal dogs). *

• Yes
• No

I agree that ownership of the OWS Canine Companion cannot be transferred to another family member, person, or organization without the written consent of OWS. *

• Yes
• No

Are your other household members agreeable to having a dog? *

• Yes
• No

Do you have other household members living with you? If yes, please include your household member’s names, ages, and their relationship to you in the space below. *

• Yes
• No

Members in My Household

Do you or any of your household members have any pet allergies? If so, please add notes below: *

• Yes
• No

Household Memeber Allergies

Are there any pet restrictions in your lease, in your association, building, etc. where you live (e.g., no pets allowed, pet weight/size limitations, quantity of pets, etc.)? If yes, please list your restrictions below: *

• Yes
• No

Pet Restrictions

I have no alcohol or legal or illegal substance abuse or dependency. *

• Yes
• No

I have no felony conviction, pending criminal charges, current parole/probation, pattern of criminality, or animal abuse. *

• Yes
• No

In the space below, please describe the areas in your life where you feel you need the most support and please describe how you feel having an OWS Canine Companion would be a benefit to you.

Submit