Canine Vision Dog Guide Expression of Interest - Lions Foundation of Canada Dog Guides

Have you reviewed the program discovery package in full?

Yes
No
I'm not sure

First name

Last name

Contact email

Contact phone

Thank you for your interest in our program

Before continuing, please review our Discovery Package with all you need to know about the program. Click here for further details.

Have you been diagnosed as Legally Blind? (either 20/200 in the better eye or a field of vision of 20 degrees or less in the better eye)

Yes
No

Thank you for your interest in our program.

Unfortunately, you do not meet the criteria for our Canine Vision program. For further information on what our Canine Vision Dogs do, please refer to our Discovery Package.

Age of applicant

Thank you for your interest in our program

Unfortunately, you do not meet the criteria for our Canine Vision program. For further information on what our Canine Vision Dogs do, please refer to our Discovery Package.

Legal guardian's name

Province or territory of residence

In order to work with a Guide Dog, you will need to independently use Orientation and Mobility skills to navigate routes around your community. How confident are you using Orientation and Mobility skills independently?

I am confident to independently navigate with little to no assistance using my orientation and mobility skills
I am somewhat confident to independently navigate with little to no assistance using my orientation and mobility skills
I am not at all confident to independently navigate with little to no assistance using my orientation and mobility skills
I do not have experience in independently navigating with little to no assistance using my orientation and mobility skills

Do you use any assistive devices for mobility?

Please describe what assistive devices you use for mobility:

Will the Canine Vision Dog Guide reside in a smoke free environment?