Skip to content

Donate | Apply For Service Dog

561.329.0277

Home
About
Our Dogs
Success Stories
How to Apply
- Eligibility & Application Process
- Service Dog Application
Ways to Help
Gallery
Blog
Contact

Home
About
Our Dogs
Success Stories
How to Apply
- Eligibility & Application Process
- Service Dog Application
Ways to Help
Gallery
Blog
Contact

Home
About
Our Dogs
Success Stories
How to Apply
- Eligibility & Application Process
- Service Dog Application
Ways to Help
Gallery
Blog
Contact

×

Home
About
Our Dogs
Success Stories
How to Apply
- Eligibility & Application Process
- Service Dog Application
Ways to Help
Gallery
Blog
Contact

Service Dog Application

In order to apply for an assistance / service dog, please fill out and submit the following form.

DO NOT COMPLETE THIS APPLICATION IF YOU ARE LOOKING FOR: Autism Dogs, ANY Medical Alert Dogs, PTSD, Emotional Support Dogs, Therapy Dogs or Facility Dogs. WE ONLY CONSIDER APPLICATIONS FOR MOBILITY ASSISTANCE DOGS!
Name*
First Last
Email*
Home-Phone
Cell-Phone
Address
Street Address Address Line 2 City State ZIP Code
Applicants Age
Month of Birth
Parents Name if applicant is a minor
What do you think an Assistance Dog can do for you?
Primary Disability:
Cause of Disability:
Effects of Disability:
Mobility Aids:
By checking here I understand that I am applying for a Mobility Assistance Dog.
- Mobility Assistance Dog
How did you hear about Genesis Assistance Dogs?
PLEASE NOTE:
As of January 2019 our waiting time from initial application approval to placement of an assistance dog is approximately 24 – 30 months.
Email
This field is for validation purposes and should be left unchanged.

Genesis Assistance Dogs, Inc.

Mailing Address:
P.O. Box 3101, West Palm Beach, FL 33402
info@genesisassistancedogsinc.org
(561) 329-0277

Genesis Service Dogs in the News

Iggy & Family Changing Pet Lives in WPB!

It’s here! Welcome to our new and improved website!

Oliver is honored by Lake Brantley High School 2019 Yearbook Staff!

Copyright © 2019 Genesis Assistance Dogs

Website by Granat Design | Login

Scroll to Top