PRINTABLE APPLICATION FOR SERVICE QUALITY PUPPY

GABBY JACK RANCH APPLICATION PACKET

Canine Service Connection

dba, Gabby Jack Ranch, Service Companions

(Mailing Address) PO BOX 1304

Penn Valley, California 95946-1304

www.gabbyjackranch.org

Thank you for your interest in the Gabby Jack Ranch.

We Provide:

• Labradoodle, Goldendoodle or North American Retriever puppy bred and raised in-home by loving families that prepare your puppy for a variety of living environments

• Initial puppy socialization through our Puppy Pre-school program

• Expert matching of puppy traits, strengths and personality to your specific needs

• Early placement to improve imprinting, bonding and dog-human communication

• Support and suggestions to help you select the best training method and goals for your dog

• When appropriate, and only when qualified, we provide Service Dog Certification (dog vest, certification card, ADA information, additional costs to cover testing, certification and supplies may apply)

What we require from you:

• Make a commitment to a quality, positive reinforcement training program, providing proof of your enrollment and participation

• Love, nurture and care for your dog

• Groom, exercise and train your dog

• Provide a safe, healthy home environment for your dog

· If necessary, provide proof of a capable and willing Facilitator (puppy raiser) to work with you

Brief Summary of Application Process; ALL INFORMATION YOU PROVIDE IS CONFIDENTIAL:

• Submit Application, fees and, when required, supporting materials and deposits (supporting materials may include things such as a video of your home, medical verification, etc.)

• Participate in interview(s) with Gabby Jack Ranch staff (Facilitator as well, if needed)

• We will notify you if you are approved. Approval does not guarantee a dog

• As dogs become available the puppies are carefully matched with approved clients.

• If you are completing this application process for a child or legal guardianship relation, please direct the information to the applicant and the applicant's home and community. It is important that we know as much as possible about the applicant so that we might determine if our program suits the needs of the applicant. Any use of the term "you" or "your" relates to the applicant.

Please understand that we are offering you an intelligent, sensitive, educable puppy, carefully nurtured and raised to be a loving companion. Your puppy has been uniquely socialized to approach new things with confidence. We make no promises that your puppy will learn or excel in any training program, learning tasks or adjusting to his/her environment. Nor do we claim that (s)he will be free from training challenges. Clearly, any puppy, especially sensitive, intelligent ones, must have respect and kind, systematic guidance. The success of your puppy will depend on your relationship to the pup; the training protocol you select, the efforts you make, how well you understand your puppy and your communication skills.

APPLICATION: PHASE ONE*

*If approved there will be a phase two, including interview and possibly additional information gathering and sharing.

1. Complete and return the attached application

2. Submit the application fee ($20) with your completed application; please understand that your application fee is non-refundable and does not contribute to the assistance dog fee.

3. Provide two letters of reference. These references should indicate how we might reach them if we desire to follow up.

4. Attach a two page essay that tells us who you are and what your training goals are, what assistance or tasks you hope to accomplish with your dog. Write this on behalf of the child or guardianship relation, if you are submitting the application on their behalf.

5. Be aware that Gabby Jack Ranch currently charges $2500 for an assistance quality puppy. We ask that if you are unable to pay this fee, you make a commitment to fundraise to purchase a dog.

APPLICATION PHASE TWO:

1. You may require or wish to have a facilitator (sometimes known as a puppy raiser) to help you train and socialize your young puppy. The facilitator will be someone that you select and we screen for approval. Obviously, the facilitator must agree to the demands of puppy raising. Once approved, we will coordinate with your facilitator to see that they have tools to raise your puppy. The facilitator will be required to coordinate a training program. Training is not provided by the Gabby Jack Ranch so training costs will be your responsibility. Any training program must be approved by the Gabby Jack Ranch. It is critical that your facilitator is close proximity to you so that you will have daily access to, and co-training time with, your puppy. Therefore, it is wise to select someone in your family, neighborhood or community to work help you raise and train your puppy. You and/or your facilitator is will receive your puppy at an early age (8 to 16 weeks).

2. We will conduct extensive interviews with you, your facilitator and your family. This helps us determine canine readiness, your goals/expectations and identify certain traits and skills necessary for your puppy. These interviews will not take place until your application is approved.

CONDITIONS:

1. You may be asked to provide more information. Your request for a puppy may be declined at any time during this application process and prior to delivery of the puppy. The puppy may be removed from a home if it is determined that the puppy is being abused, mistreated or neglected.

2. We will select your puppy, based on temperament matching, personality, observation and needs assessment. You will NOT be assigned a puppy based on gender, color, coat quality or appearance. You may not select your own puppy.

3. When you have been approved for a puppy, we will require a deposit in the amount of $500. This deposit will be applied towards the assistance dog fee of $2500. We use these funds to pay for vet care and spay/neutering of your puppy. In other words, when a dog has been identified for you, you will pay a $500 deposit but will still owe $2000 before the dog will be formally placed with a facilitator and/or you. This deposit will only be requested once a puppy is assigned to you and then the deposit is non-refundable.

4. Payment in full is required two weeks prior to delivery of the puppy. No exceptions. Payments must be made by personal check, cashier's check or money order for the exact amount of the purchase, funds must clear the bank before the puppy is delivered. You may be required to provide proof of funds clearing before your puppy is transported. Payments may be made electronically through PayPal.

5. Transportation and delivery costs are additional. This includes, but is not limited to, costs of crates, transportation fees/regulatory charges, air fare, ground transportation or personal delivery charges.

6. We require that you make a commitment to your puppy, to learning your role in this dog/human partnership. This is a long-term commitment and you will be working multiple times a day with your puppy so that he/she can learn what is expected of him/her. We expect that your goal in selecting a Gabby Jack Ranch dog is for you to form a partnership with your dog; a partnership that will support you and empower you to have more control over the circumstances of your life.

7. We provide high quality dogs. Gabby Jack Ranch’s policy is to certify you for public access, only when appropriate. If you request Gabby Jack Ranch certification, there are additional fees and testing/verification requirements. You will need to provide medical verification for a service dog. If Gabby Jack Ranch examiners must travel to you, you will be responsible for their reasonable expenses.

8. You will be required to sign a contract. You will have ownership of the puppy but certain important conditions will apply. If ever the puppy is subject to abuse or neglect, it will be immediately turned back in to Gabby Jack Ranch, without notice or hearing. If you decide, at any time, that you are unable to keep your dog, you agree to notify Gabby Jack Ranch immediately and return the dog to us for re-homing. There will be no refund for re-homing situations. This placement is not transferrable. Other conditions will apply and will be clearly explained to you before you are asked to sign a contract or give your deposit.

By making an application for a Gabby Jack Ranch puppy, you agree that you have read and understand Application: Phase One, Application: Phase Two, the conditions and the information stated above. You further agree that the material you provide is a true and correct assessment of your living, financial and medical situation so that we are able to select the best puppy for your needs. _________ Initial here.

Signature: __________________________________________ Dated: ____________________________

CONTINUE TO THE NEXT PAGE

Canine Service Connection

dba, Gabby Jack Ranch, Service Companions

(Mailing Address) PO BOX 1304

Penn Valley, California 95946-1304

www.gabbyjackranch.org

Application For A Gaby Jack Ranch Dog

Please print this form, fill in, attach additional sheets, if necessary.

You may fax, scan or mail a copy to Gabby Jack Ranch

Applicant Name: _________________________________________________________________________________________________________________________

How did you hear about the Gabby Jack Ranch? _________________________________________________________________________________________________________________________

**If the applicant is a minor, please list the name and contact information of a parent or responsible guardian here, parent or guardian must sign this application for client. If you are completing this on behalf of a child or person under your legal guardianship, please provide information related to the applicant so that we can match the client with a suitable companion service dog. All questions apply to the client and the ultimate home environment for the dog. Provide summary of who filled in form on whose behalf please: __________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

APPLICANT INFORMATION

Applicant Address: _________________________________________________________________________

City, State, Zip: ___________________________________________________________________________

Telephone Number: _______________________________________________________________________

Alternate Telephone Number: ________________________________________________________________

E-mail Address: ___________________________________________________________________________

Would you like to apply for a Gabby Jack Ranch Service Dog in Training vest? If so, we will send you an application and contract for this service. There will be a $100 fee. Yes No

__________________________________________________________________________________________________________________________

Do you have pet allergies? Yes No

Are you: Single

Married/Domestic Partnership

Divorced

Separated

Widowed

Do you have children? Yes No

If yes, how many (please list first names and ages):

__________________________________________________________________________________________________________________________

Applicant Home

Do you (check all that apply):

Own your home

Rent

Other, explain

Live in a Condominium

Live in Group home/Assisted Living

Live in an Apartment

Other: __________________________________________________________________________________________________________________________

Do you live:

Alone

With spouse/domestic partner

With children, names/ages if different from above list:

__________________________________________________________________________________________________________________________

With parents

Other, explain: ____________________________________________________________________________________________

____________________________________________________________________________________________

Please list names/relationships of those living with you (if not listed above):

____________________________________________________________________________________________

Do you have a fenced yard? Yes No

Do you have a large, fenced area where your dog can run off-leash for exercise? Yes No

Do you have a nearby safe location to practice training? Yes No

Describe: ________________________________________________________________________________

Your Income

What is your combined, monthly, household income (include all sources)?

$_________________________________________________________________________________________________________________________

Do you or your spouse/domestic partner receive government benefits? Yes No

SSI, please list monthly amount and recipient's name: _____________________________

SSDI, please list monthly amount and recipient's name: ___________________________

Other, please list monthly amount, source, and recipient's name: _____________________

Your Disability

Please describe your disability: ________________________________________________________________

_________________________________________________________________________________________________________________________

When were you diagnosed? __________________________________________________________________

What items or assistive devices do you use for support (we need this information to determine how to best get your puppy accustomed to your lifestyle)?

Cane - crutches

Wheelchair (motorized)

Wheelchair (manual)

Shower Assist

Bed/Chair Assist

Vehicle lift devices (hydraulic lift on a van or bus)

Other, explain: ____________________________________________________________

What is your activity level? low moderate high

Please explain: ____________________________________________________________________________

_________________________________________________________________________________________________________________________

Are you able to verbally communicate? Yes No

If no, what form of communication will you use with your dog? ______________________________________

_________________________________________________________________________________________________________________________

Your family, community

It is important to Gabby Jack Ranch to ensure the best possible home and care for the dog. To that end, we are concerned with certain conditions or environments that are most suitable, Please use additional pages if necessary. If this application is being completed on behalf of a child or other legal guardianship please focus information on the applicant, the applicant's living conditions and circumstances including adults residing at the applicant's home.

Describe your home environment: ____________________________________________________________

__________________________________________________________________________________________________________________________

Describe your local community: _______________________________________________________________

________________________________________________________________________________________________________________________

Are family, roommates etc. aware and supportive of you getting a dog to train as a service companion?

Yes No Somewhat, explain: _________________________________________________

_________________________________________________________________________________________________________________________

Do you (or does anyone residing with you) have other pets? (list & explain) ____________________________

_________________________________________________________________________________________________________________________

Do you, or does anyone in your home, use mood altering drugs?

Yes No If yes, explain: __________________________________________________

_________________________________________________________________________________________________________________________

Have you, or anyone in your immediate circle of family/friends, ever been involved court cases (civil or criminal) involving violence issues including domestic violence, assault, battery or other, where anger control intervention is suggested/required?

Yes No If yes, explain: ____________________________________________________

________________________________________________________________________________________________________________________

Do you or does any adult in your household have any past, current or pending criminal violations?

Yes No If yes, explain: _________________________________________________________

_________________________________________________________________________________________________________________________

Do you have children visitors? Yes No

Do visitors bring pets to visit? Yes No

Do you often have visitors for an extended time? (Anything over a few hours on a regular basis, overnight, weekends, long-term, etc.)? Yes No

If yes, explain:________________________________________________________________________

_________________________________________________________________________________________________________________________

What do you expect will need to be evaluated and changed in order to prepare you for training a dog companion?

_________________________________________________________________________________________________________________________

Do you anticipate using a facilitator (puppy raiser) to help you train or socialize your puppy? If so, please supply the name and contact information to the person you have selected. (This person must agree to work with you and your dog.) __________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Activities, Events, Travel

What daily activities are important to you? ______________________________________________________

__________________________________________________________________________________________________________________________

Will your dog be with you when you travel? Yes No

How often? _________________________________________________________________________________________________________________________

How do you travel? (Check all that apply.)

Automobile

Bus

Airplane (Public)

Airplane (Private)

Train

Taxi

Other,explain:___________________________________________________________

_________________________________________________________________________________________________________________________

Do you drive? Yes No

Describe what type of driving you do? Commuting, road trips, please explain:

__________________________________________________________________________________________________________________________

What activities or events are important to you?

Church

Concerts

Amusement Parks

Theatre

Movies

Street Fairs/Markets

Shopping

Car Racing

Sporting Events

The circus

Other quiet events: ______________________________________________________

Other loud, crowded or active events: ________________________________________

Employment, School

Are you employed? Yes No

If yes, is your work Full time, 8 hours per day, M-F 8 a.m. to 5 p.m. or describe:

________________________________________________________________________________________

Part time, what days/hours?

________________________________________________________________________________________

Other, explain:

__________________________________________________________________________________________________________________________

Where do you work?

__________________________________________________________________________________________________________________________

Will you take your dog to work? Yes No

What type of work do you do?

__________________________________________________________________________________________________________________________

How will your work life change by having a dog? _______________________________________________

__________________________________________________________________________________________________________________________

Are you a student? Yes No

Where do you attend school? ________________________________________________________________

What days do you attend school?

Monday, from ______________________ until ___________________

Tuesday, from ______________________ until __________________

Wednesday, from ___________________ until ___________________

Thursday, from _____________________ until ___________________

Friday, from ________________________ until ___________________

What do you study?________________________________________________________________________

__________________________________________________________________________________________________________________________

When you complete school, do you have a career in mind? Explain

__________________________________________________________________________________________________________________________

Please explain, in detail, your experience with dogs. __________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Are you comfortable with dogs? Yes No

If no, explain: ___________________________________________________________________________

__________________________________________________________________________________________________________________________

Have you, or someone close to you or someone living in your household, ever had a bad experience with a dog? Yes No

If yes, explain: ___________________________________________________________________________

__________________________________________________________________________________________________________________________

What dog traits do you like?

__________________________________________________________________________________________________________________________

What dog traits do you dislike?

__________________________________________________________________________________________________________________________

How will you handle any unexpected indication of fear or aggression against your dog (from people or other dogs)? __________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

How will you handle any unexpected indication of fear or aggression expressed by your dog (toward any person, animal or other dog)?

__________________________________________________________________________________________________________________________

Do you, and others in your household, understand that your dog may dig, chew, urinate on, or otherwise destroy landscaping, valuable possessions or home furnishings? Yes No

How will you handle these behaviors?

___________________________________________________________________________________________________________________________

How much do you believe you will pay, per month, on routine care for your dog? Please list the expenses you anticipate and the approximate cost of routine care (vet care, medication, flea/tick/heartworm preventative treatments, grooming, supplies, food, etc.) $___________________________________________________

Is there anything you would like us to consider that is not fully covered in this application?

___________________________________________________________________________________________________________________________

Thank you, we know this is not an easy process, but your candid responses will help us to determine which puppy is the right one for you!