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Private Certification Application

PLEASE NOTE:
This program has been established for Veterans and First Responders to train their own dogs as assistance dogs. Due to t he nature of our program we do not cater to other individuals due to the unique culture of these services.


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

Please add your surname
Please type your first name.
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Please load an image for your ID card
Please enter your date of birth in the format dd/mm/yy
Please add your street number and name
Please add your suburb
Please add your city
Please add your post code
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Disability / Health Information

Please detail your disability and if there are any issues that may restrict you from training your dog

please describe your disability

Other Health Issues

Do you have any other health issues or concerns?

If Yes, please describe(*)
If Yes, please describe
Please select and option

Please detail any other health issues we should be aware of that could impinge on your ability to train you dog

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How is your health aside from you disability(*)
How is your health aside from you disability
please select and option
How would you describe your activity level? (*)
How would you describe your activity level?
please make a selection

Employment Information

Do you currently work?(*)
Do you currently work?
Please select and option
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Assistance Dog Information

Please add your dog's name
please add the breed of the dog
Please select a date for the birth of your dog
Please add the microchip number of your dog
Has your dog been desexxed?(*)
Has your dog been desexxed?
please make a selection
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Does your dog have any health issues?(*)
Does your dog have any health issues?
Please select and option
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Is you dog thoroughly toilet trained?(*)
Is you dog thoroughly toilet trained?
please select and option
Are there any additional tasks you wish your dog to perform?(*)
Are there any additional tasks you wish your dog to perform?
please select and option
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What basic commands can you dog respond to?(*)
What basic commands can you dog respond to?
please select some options
Please provide a photo ID of your Dog
Sex of Dog
Sex of Dog
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please enter your dog's weight
Is your Dog Vaccinated?(*)
Is your Dog Vaccinated?
Please make a selection
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Has you dog ever bitten or growled at anybody?(*)
Has you dog ever bitten or growled at anybody?
Please make a selection
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please note the function your dog performs
How would you describe your dog's temperament?(*)
How would you describe your dog's temperament?
please select and option
please add the name of your vet
please include the vets address
please include the vets phone number
Consent to Contact Vet(*)
Consent to Contact Vet
please make a selection

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.

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