Retrieving Independence
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Retrieving Independence
Request for Facility Dog Application
Person inquiring about Facility Dog
*
First Name
*
Last Name
*
Email
*
Phone Number
*
Relationship to the facility
Facility Information
*
Name of Facility Applying
* Type of Facility
School
Medical Facility
Government Facility
Privately Owned Facility
Other
If other, please explain.
*
Facility Full Address
*
Describe your facility's needs as it relates to a facility dog.
* I understand there is a $200, non-refundable application fee. This fee is not applied toward the facility dog placement fees.
Yes
No
* I understand there must be a Primary Handler and a Secondary Handler for the Facility Dog that will be approved by the RI Staff
Yes
No
* I understand the total investment of a Facility Dog is $5,000
Yes
No
* I understand there will be required training by the RI Staff with placement of a dog within this facility.
Yes
No
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