BRAVEHOUND SUPPORTING VETERANS

Assistance Dog Application

PERSONAL INFORMATION

Title

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Full Name *

Your full legal name as it appears on documents.

This field is required.

Date of Birth

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Email Address *

Your active email address for communication purposes.

This field is required.

Phone Number *

Your contact number.

This field is required.

Address

Your current residential address.

Address Line 1 *

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Address Line 2

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City *

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County

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Postal Code *

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MEDICAL INFORMATION

Do you have a diagnosed PTSD condition? *

Yes

No

This field is required.

Supported by (e.g. Combat Stress / GP) *

This field is required.

How can an assistance dog help you *

This field is required.

YOUR MILITARY SERVICE DETAILS

Branch of Service (e.g. Army, RN, RAF, MN) *

This field is required.

Service No. *

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Rank *

This field is required.

Regiment, Ship etc. *

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Date of Joining *

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Date of Discharge *

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Details of where you served  *

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YOUR HOUSEHOLD

Number of Adults *

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Number of Children *

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What type of accommodation do you live in *

Select an option House Flat Bungalow Other

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Do you *

Select an option Own Rent Other

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Do you have a garden *

Select an option Yes No Shared

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Do you have other pets? *

Yes

No

This field is required.

Please provide details

EMPLOYMENT DETAILS

Are you employed? *

Yes

No

This field is required.

Current employment

Working hours

Can you take the dog to work with you?

Yes

No

Additional Comments or Information

Feel free to provide any additional information or comments.

YOUR DECLARATION
By signing this agreement, I declare that the information given is correct and complete to the best of my knowledge.
BRAVEHOUND will use the information provided in the application form to process and assess your information for the BRAVEHOUND Training Programme.
To agree please type your name in the box provided below: 

Signature *

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I consent to BRAVEHOUND storing my submitted information so they can respond to my inquiry. *

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Submit

Using your personal information:
BRAVEHOUND will use the information provided to assess your programme suitability allowing us to contact you directly regarding your application. We will not disclose any information to 3rd parties.

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