Apply for a BRAVEHOUND↵

BRAVEHOUND SUPPORTING VETERANS

If you are human, leave this field blank.

BRAVEHOUND Assistance Dog (* Mandatory fields)

PERSONAL INFORMATION

Title

First Name *

Last Name *

Known as

Date of Birth

Address *

Telephone *

Email

MEDICAL INFORMATION

Do you have a diagnosed PTSD condition *

-YesNo

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

How can an assistance dog help you *

YOUR MILITARY SERVICE DETAILS

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

Service No. *

Rank

Regiment, Ship etc. *

Date of Joining *

Date of Discharge *

Details of where you served

Are you currently serving in the armed forces or employed in emergency services *

-YesNo

YOUR HOUSEHOLD

Number of Adults *

Number of Children *

What type of accommodation do you live in *

-HouseFlatBungalowOther

Do you *

-OwnRentOther

Do you have a garden *

-YesNoShared

Do you have other pets *

-YesNo

Please provide details

EMPLOYMENT DETAILS

Are you employed *

-YesNo

Current employment

Working hours

Can you take the dog to work with you

-YesNo

* * *

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 *

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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