Expression of Interest – Form Complete your expression of interest What kind of assistance dog are you interested in applying for?*Service Dogs: For individuals with physical disabilities PTSD Service Dog: For 1st Responders and veterans (ONLY) with PTSD Hearing Dog: perform sound alerts such as timer, phone, doorbell, name call, baby's cry, etc for deaf or hard-of-hearing individuals Accredited Facility Dog: Partnered with community professional - victim services, courthouse, child advocacy, education, etc Other: PTSD Dog for applicants that are not 1st Responders or Veterans, Diabetic Alert Dog, Autism Support Dog, Guide Dog, Seizure Response Dog, etc Service Dog PTSD Service Dog Hearing Dog Accredited Facility Dog Other Are you military/veteran or first responder?* Yes No PTSD Service DogsPADS Currently only places PTSD Service Dogs with veterans or first responders. Please visit Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find another school.Other Types of Assistance DogsPADS Currently only places Service (Mobility & PTSD), Hearing and Accredited Facility Dogs. If you are looking for a different type of assistance dog (i.e. guide, seizure alert, diabetic alert, etc) please visit Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find a school that trains the type of assistance dog you are seeking. Age to ApplyPADS currently only accepts applications for: Service Dogs: 16 years of age or older Hearing, PTSD, Accredited Facility Dogs: 18 years of age or olderDo you currently meet the age requirement for applicants for the type of dog you're applying for?* Yes No Unfortunately we are unable to serve your needsWhile we are not able to serve your needs at this time, please consider applying for a VIP (Very Important Pet) until such time you are old enough to be considered. Visit pads.ca/vip for more information. Regions ServedPADS Currently only places dogs in the following regions: Service & Hearing dogs: BC, Alberta, Saskatchewan, Manitoba, Northwest Territories, Yukon. PTSD Service Dogs: Greater Vancouver, BC, Kelowna, BC & Calgary, AB Accredited Facility Dogs: Nationwide (Canada) Do you live in one of the serviced regions for the type of dog you are interested in applying for?* Yes No Canadian CitizenshipAre you a Canadian Citizen or Permanent Resident?* Yes No Unfortunately we are unable to serve your needs at this timePADS is unfortunately unable to place dogs outside of these regions at this time. Please visit Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find a school that serves your geographic region. Would you like to be notified if we provide PTSD Dogs in your region in the future?While we are only able to place and support PTSD Clients in Greater Vancouver and Calgary at this time, we hope to expand this in the future. It would help us identify where the need is greatest and contact you when we do expand if you filled out the information below. Please note, this expansion is likely years away, so please consider visiting Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find a school that serves your geographic region at this time. Yes No About youBirthdate* YYYY dash MM dash DD Gender* Please describe your living situation:*For example are you in apartment, house, etc? Urban/Rural? How many/ages of family members, roommates, etc? Do you have other pets? If you have a yard is it fenced? Please describe in detail your life, work, activities, etc*Do you work outside the home, where and how often do you socialize, what kinds of activities do you participate in, hobbies, etc. Please describe your activity level*Physical activity that would include your assistance dog in future (walks, hikes, runs, bike rides, etc) Very Active (Daily Physical Activity - 1 hr or more) Active (Daily Physical Activity - Less than 1 hr) Moderately Active (Weekly Physical Activity) Less Active (Less than once per week) PTSD DogAre you currently in active duty/service?* Yes No Please describe how you hope a PADS PTSD Service Dog will support your independence?* Hearing DogPlease describe how you hope a PADS Hearing Dog will support your independence??* AFD - Team QuestionsWhat field do you work in?* Education Victim Services Child Advocacy Healthcare Is your victim services program?* Police/RCMP Staffed Civilian Staffed What types of individuals/settings do you anticipate the dog working in?*Check all that apply. If there are other settings, please include them in your answer to the next question. Children Adults Forensic Interviews Courtroom Court Prep Field (Crime/Trauma Scene) 1-to-1 Counselling Sessions Group Therapy Play Therapy What types of individuals/settings do you anticipate the dog working in?*Check all that apply. If there are other settings, please include them in your answer to the next question. Children Adults Forensic Interviews Palliative Care Recreation Emergency Room Group Therapy Private (1-to-1) therapy sessions First Responders Rehabilitation Therapy Addiction Services What types of settings do you anticipate the dog working in?*Check all that apply. If there are other settings, please include them in your answer to the next question. Elementary Secondary Post-Secondary Classroom Counselling Office Administrators Office Please describe your work environment*For example: What kinds of clients do you serve, feel free to elaborate or expand on the environments noted above. Please describe how you hope a PADS Accredited Facility Dog will support your work & the people you serve?* Service DogPlease answer these questions as honestly as possible - there is no right or wrong answers. If you want to add more detail to any of the multiple choice questions - please do so in the final question of this section. Please describe how you hope a PADS Service Dog will support your independence?*What kinds of tasks do you need the dog to perform, how do you hope the dog will improve the quality of your life, etc. I can pick up an object off the floor* Always Often Sometimes Never I can pick up items off a chair* Always Often Sometimes Never I can pick up items off a table* Always Often Sometimes Never I can push elevator buttons* Always Often Sometimes Never I can turn On/Off light switches* Always Often Sometimes Never I can open drawers and cabinets* Always Often Sometimes Never I can push myself in a manual chair* Always Often Sometimes Never Not Applicable I can lift my arms* Always Often Sometimes Never I can walk/ambulate* Always Often Sometimes Never Please describe your physical abilities & limitations*For example: physical strength, dexterity, etcWhat type of Assistive Devices do you use*Please check any/all that apply Wheelchair (Manual) Wheelchair (Manual w/Power Assist) Wheelchair (Power) Scooter Walker Cane Arm Crutches None What assistive device do you use most* Wheelchair (Manual) Wheelchair (Manual w/Power Assist) Wheelchair (Power) Scooter Walker Cane Arm Crutches None Emergency ContactsPlease provide the name and contact information for two people that we can reach out to if needed (in your family, friends, support network). Person 1: First Last Email PhonePerson 2 First Last Email Phone Your Contact InformationName* First Last Email* Organization* Role/Job Title* Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone 1*Phone 1 Type*HomeCellWorkPhone 2Phone 2 TypeHomeCellWorkPADS may use my contact information for the following purposes:*Please check any/all that apply Select All Regarding applying for an assistance dog With general communications from PADS (upcoming events, fundraising, eNewsletter, etc) CAPTCHACommentsThis field is for validation purposes and should be left unchanged. What kind of assistance dog are you interested in applying for?*Service Dogs: For individuals with physical disabilities PTSD Service Dog: For 1st Responders and veterans (ONLY) with PTSD Hearing Dog: perform sound alerts such as timer, phone, doorbell, name call, baby's cry, etc for deaf or hard-of-hearing individuals Accredited Facility Dog: Partnered with community professional - victim services, courthouse, child advocacy, education, etc Other: PTSD Dog for applicants that are not 1st Responders or Veterans, Diabetic Alert Dog, Autism Support Dog, Guide Dog, Seizure Response Dog, etc Service Dog PTSD Service Dog Hearing Dog Accredited Facility Dog Other Are you military/veteran or first responder?* Yes No PTSD Service DogsPADS Currently only places PTSD Service Dogs with veterans or first responders. Please visit Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find another school.Other Types of Assistance DogsPADS Currently only places Service (Mobility & PTSD), Hearing and Accredited Facility Dogs. If you are looking for a different type of assistance dog (i.e. guide, seizure alert, diabetic alert, etc) please visit Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find a school that trains the type of assistance dog you are seeking. Age to ApplyPADS currently only accepts applications for: Service Dogs: 16 years of age or older Hearing, PTSD, Accredited Facility Dogs: 18 years of age or olderDo you currently meet the age requirement for applicants for the type of dog you're applying for?* Yes No Unfortunately we are unable to serve your needsWhile we are not able to serve your needs at this time, please consider applying for a VIP (Very Important Pet) until such time you are old enough to be considered. Visit pads.ca/vip for more information. Regions ServedPADS Currently only places dogs in the following regions: Service & Hearing dogs: BC, Alberta, Saskatchewan, Manitoba, Northwest Territories, Yukon. PTSD Service Dogs: Greater Vancouver, BC, Kelowna, BC & Calgary, AB Accredited Facility Dogs: Nationwide (Canada) Do you live in one of the serviced regions for the type of dog you are interested in applying for?* Yes No Canadian CitizenshipAre you a Canadian Citizen or Permanent Resident?* Yes No Unfortunately we are unable to serve your needs at this timePADS is unfortunately unable to place dogs outside of these regions at this time. Please visit Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find a school that serves your geographic region. Would you like to be notified if we provide PTSD Dogs in your region in the future?While we are only able to place and support PTSD Clients in Greater Vancouver and Calgary at this time, we hope to expand this in the future. It would help us identify where the need is greatest and contact you when we do expand if you filled out the information below. Please note, this expansion is likely years away, so please consider visiting Assistance Dogs International or the Canadian Association of Guide and Assistance Dog Schools to find a school that serves your geographic region at this time. Yes No About youBirthdate* YYYY dash MM dash DD Gender* Please describe your living situation:*For example are you in apartment, house, etc? Urban/Rural? How many/ages of family members, roommates, etc? Do you have other pets? If you have a yard is it fenced? Please describe in detail your life, work, activities, etc*Do you work outside the home, where and how often do you socialize, what kinds of activities do you participate in, hobbies, etc. Please describe your activity level*Physical activity that would include your assistance dog in future (walks, hikes, runs, bike rides, etc) Very Active (Daily Physical Activity - 1 hr or more) Active (Daily Physical Activity - Less than 1 hr) Moderately Active (Weekly Physical Activity) Less Active (Less than once per week) PTSD DogAre you currently in active duty/service?* Yes No Please describe how you hope a PADS PTSD Service Dog will support your independence?* Hearing DogPlease describe how you hope a PADS Hearing Dog will support your independence??* AFD - Team QuestionsWhat field do you work in?* Education Victim Services Child Advocacy Healthcare Is your victim services program?* Police/RCMP Staffed Civilian Staffed What types of individuals/settings do you anticipate the dog working in?*Check all that apply. If there are other settings, please include them in your answer to the next question. Children Adults Forensic Interviews Courtroom Court Prep Field (Crime/Trauma Scene) 1-to-1 Counselling Sessions Group Therapy Play Therapy What types of individuals/settings do you anticipate the dog working in?*Check all that apply. If there are other settings, please include them in your answer to the next question. Children Adults Forensic Interviews Palliative Care Recreation Emergency Room Group Therapy Private (1-to-1) therapy sessions First Responders Rehabilitation Therapy Addiction Services What types of settings do you anticipate the dog working in?*Check all that apply. If there are other settings, please include them in your answer to the next question. Elementary Secondary Post-Secondary Classroom Counselling Office Administrators Office Please describe your work environment*For example: What kinds of clients do you serve, feel free to elaborate or expand on the environments noted above. Please describe how you hope a PADS Accredited Facility Dog will support your work & the people you serve?* Service DogPlease answer these questions as honestly as possible - there is no right or wrong answers. If you want to add more detail to any of the multiple choice questions - please do so in the final question of this section. Please describe how you hope a PADS Service Dog will support your independence?*What kinds of tasks do you need the dog to perform, how do you hope the dog will improve the quality of your life, etc. I can pick up an object off the floor* Always Often Sometimes Never I can pick up items off a chair* Always Often Sometimes Never I can pick up items off a table* Always Often Sometimes Never I can push elevator buttons* Always Often Sometimes Never I can turn On/Off light switches* Always Often Sometimes Never I can open drawers and cabinets* Always Often Sometimes Never I can push myself in a manual chair* Always Often Sometimes Never Not Applicable I can lift my arms* Always Often Sometimes Never I can walk/ambulate* Always Often Sometimes Never Please describe your physical abilities & limitations*For example: physical strength, dexterity, etcWhat type of Assistive Devices do you use*Please check any/all that apply Wheelchair (Manual) Wheelchair (Manual w/Power Assist) Wheelchair (Power) Scooter Walker Cane Arm Crutches None What assistive device do you use most* Wheelchair (Manual) Wheelchair (Manual w/Power Assist) Wheelchair (Power) Scooter Walker Cane Arm Crutches None Emergency ContactsPlease provide the name and contact information for two people that we can reach out to if needed (in your family, friends, support network). Person 1: First Last Email PhonePerson 2 First Last Email Phone Your Contact InformationName* First Last Email* Organization* Role/Job Title* Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone 1*Phone 1 Type*HomeCellWorkPhone 2Phone 2 TypeHomeCellWorkPADS may use my contact information for the following purposes:*Please check any/all that apply Select All Regarding applying for an assistance dog With general communications from PADS (upcoming events, fundraising, eNewsletter, etc) CAPTCHANameThis field is for validation purposes and should be left unchanged.
