Application

This form is to be completed by the applicant or by a parent in the applicant is a minor, or an authorised representative if the applicant is a ward of the court.

Surname(*)

Please add your surname

First Name(*)

Please type your first name.

Home phone

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Mobile phone

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Work Phone

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E-mail(*)

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Load image

Please load an image for your ID card

Date of Birth(*)

Please enter your date of birth in the format dd/mm/yy

Street No and Name(*)

Please add your street number and name

Suburb(*)

Please add your suburb

City / Town(*)

Please add your city

Postcode(*)

Please add your post code

State(*)

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Assistance Dog Information

By submitting the information above by way of clicking the submit button,
I understand that this is an application only, and that there are no guarantees of acceptance.

I understand that Hounds 4 Healing Inc. reserves the right to refuse my application at any stage in the process.

Once I have been informed that my dog has been accepted for an initial assessment only and confirmed a date and time of assessment for suitability to join t he program, I will submit my $150 application fee which I acknowledge is non-refundable.

I understand that providing false or misleading information to Hounds 4 Healing Inc. will result in my dismissal from the program.

I also acknowledge that I will be required to pay the $1500 course fee prior to the conclusion of the course in accordance with the payment structure.

Private Certification Application

Disability / Health Information

Employment Information

Assistance Dog Information