Register your interestRegister todayStep 1 of 333%PART 1 Personal DetailsVeteran Name(Required) First Last Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code PhoneEmail(Required) Date(Required) MM slash DD slash YYYY Military Service(Required) British Millitary Reservist Merchant NavyService Number(Required)Branch / Unit / Regt. / Corps / Ship(Required)Marital Status: Single Divorced Domestic Partner Married Seperated Not StatedCurrent Situation Employed Retired Sick Leave Unemployed Disabled from work OtherIf employed please provide the your job roleWhere did you hear about Veterans With Dogs?Do you already own a dog? Yes NoPERSONAL NEEDSPlease state your primary mental health conditionHave you received a clinical diagnosis? Yes NoBriefly tell us about your mental health difficulties and how these affect day to day living?Do you have any physical disabilities? Yes NoDo you understand that we do not train or provide dogs for physical disabilities? Yes NoDo you require the use of walking aids, such as a stick, a scooter or other aid? Yes NoPlease tell us about any physical disabilitiesPlease give your reasons for needing an assistance dogPlease answer the following:Do you rely on someone to meet your daily care needs? Yes NoAre you able to properly walk a dog – without walking aids – for at least 45 mins a day? Yes NoDo you have direct access to your own enclosed garden or yard area and outdoor space? must be secure and not a shared space or communal area) Yes NoDo you have any children or dependents under the age of 5 years old? Yes NoWould an assistance dog accompany you to work? Yes NoHow many hours a day would you foresee having to leave an assistance dog alone?PART 3 Other informationUse this section to provide any further information you feel we should know at this stage – including further details of disabilities, personal circumstances, and information regarding existing pets.Data Protection and Declaration I agree to the privacy policy.Data Protection and Declaration VETERANS WITH DOGS adheres to the Data Protection Act 2018. Your information will be treated confidentially, stored securely, and used solely for providing our services. By submitting this enquiry, you confirm the accuracy of the information provided and consent to its storage and use by VETERANS WITH DOGS. I understand and agree that: This is a Register of Interest, not a full application, and confers no entitlement. I have read and understood the FAQs on the website. I consent to eligibility checks. I have a mental health diagnosis from a qualified clinical professional. All statements provided are true and factual to the best of my knowledge. I understad that I must attend a ‘Meet & Greet’ day in Devon and complete a full application for services. I will attend residential training in Devon and regular local training sessions. I am responsible for the estimated £150+ monthly cost of caring for an assistance dog. A full DBS check will be conducted prior to dog placement. You will receive a copy of this form for your records upon submission.
