Service Dog Registration Application

👤 Handler / Owner Information

First Name *

Last Name *

Gender

Date of Birth

Email Address *

Phone Number

Marital Status

Mailing Address

🐾 Pet Information

Pet Name *

Pet Breed *

Pet Type

Number of Pets

Pet Weight (lbs)

Pet Color

🏅 Service Classification

👂 Hearing Assistance Service Dog

Certified Intensive Service Dog Course (120 hrs)

🧠 Psychiatric Service Dog (PSD)

Psychiatric Service Dog Course (80 hrs)

❤️ Therapy / Emotional Support Dog

Basic Obedience & Therapy Dog Course (40 hrs)

📸 Pet Front Photo

📷

Tap to upload or take a photo

Clear front-facing photo of your pet · JPG, PNG, WebP (max 5MB)

By submitting this application, you confirm that all information provided is accurate.
Your certificate will be processed and issued within 7 business days.

🔒 Your information is protected under our privacy policy. We do not share your personal data with third parties. Registration is governed by the Americans with Disabilities Act (ADA).

Service Dog RegistrationApplication

Registration Submitted!

Service Dog Registration
Application