Service Dog Guide Expression of Interest - Lions Foundation of Canada Dog Guides

Name

First

Last

Contact email

Contact phone

Age

Thank you for your interest in our Service Dog Guide Program. After reviewing your information, we regret to inform you that you do not meet the eligibility criteria for the program at this time. For more information about the program, including eligibility requirements and resources please refer to the SD-Discovery-Package-2025.pdf

Legal Guardian’s Name

City

Province or Territory of residence

What is your preferred language?

English
French
I am bilingual in English and French

Have you reviewed the program discovery package in full?

Yes
No

Thank you for your interest in our Service Dog Guide Program. After reviewing your information, we regret to inform you that you do not meet the eligibility criteria for the program at this time. For more information about the program, including eligibility requirements and resources please refer to the SD-Discovery-Package-2025.pdf

Do you have a physical, debilitating chronic illness or neurological disorder affecting one or more limbs that is medically diagnosed?

Yes
No

Thank you for your interest in our Service Dog Guide Program. After reviewing your information, we regret to inform you that you do not meet the eligibility criteria for the program at this time. For more information about the program, including eligibility requirements and resources please refer to the SD-Discovery-Package-2025.pdf

dog providing wheelchair

What is your primary disability?

When were you diagnosed with this disability?

Under 1 year ago
1-5 years ago
6+ years ago

Thank you for your interest in our Service Dog Guide Program. After reviewing your information, we regret to inform you that you do not meet the eligibility criteria for the program at this time. For more information about the program, including eligibility requirements and resources please refer to the SD-Discovery-Package-2025.pdf

Do you primarily use a power wheelchair or scooter for mobility, both inside and outside the home?

Yes
No

Does anyone in your home have allergies to dogs?

Yes
No

We are not currently taking applications for those who require a hypoallergenic dog. Please check back the next time we reopen to new applicants.

Please list any other physical or medical conditions

Will you serve as the primary handler responsible for the Dog Guide’s care, training, and overall well-being? We understand that third-party support may be necessary to meet the expectations of our program, and we are committed to working with you individually to determine whether the support in place is appropriate.

Yes
No

Thank you for your interest in our Service Dog Guide Program. After reviewing your information, we regret to inform you that you do not meet the eligibility criteria for the program at this time. For more information about the program, including eligibility requirements and resources please refer to the SD-Discovery-Package-2025.pdf

Are you physically capable of working with the dog independently, including providing verbal or physical cues and offering treats, as small as an almond and praise as positive reinforcement in a timely manner?

Yes
No

Thank you for your interest in our Service Dog Guide Program. After reviewing your information, we regret to inform you that you do not meet the eligibility criteria for the program at this time. For more information about the program, including eligibility requirements and resources please refer to the SD-Discovery-Package-2025.pdf

How often do you go out in your community (Ex: stores, appointments, work, school)

Less than once a week
Once a week
More than once a week

Do you receive home care assistance, such as support from a personal support worker (PSW)?

Yes, 5+ hours per day
Yes, less than 5+ hours per day
Yes, a few times per week
No, I do not receive home care assistance

If accepted into the program, would you be available to attend in person training for up to 21 consecutive days at our facility within the next 4-18 months from the time of application?

Yes
No

Have you applied for a Dog Guide from our organization previously?

Yes
No

Will the Service Dog Guide reside in a smoke free environment?

Yes
No

Have you or any member of your household been, or are you subject to, a court order banning you from the ownership of any animal(s)?

Yes
No

Have you ever been convicted of a criminal offense?

Yes
No

Thank you for your interest in our Service Dog Guide Program. After reviewing your information, we regret to inform you that you do not meet the eligibility criteria for the program at this time. For more information about the program, including eligibility requirements and resources please refer to the SD-Discovery-Package-2025.pdf

How did you hear about Lions Foundation of Canada Dog Guides (LFCDG)?