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If you are interested in applying for a Hearing Dog or would like more information about our program, please contact the Dog Ears program at Anne's Country Club for Pets in Oklahoma City at (405) 478-2303.  Request For Application:
NOTE: THIS IS NOT THE APPLICATION, BUT A REQUEST FOR AN APPLICATION
For one page printable version: (PDF file)
Or, for easy printing, print out this page for a 2 page format.
Please Print and Complete REQUEST Form and Mail to:
Dog Ears
4200 E. Britton Road
Oklahoma City, OK 73131
(405) 478-2303 voice or via relay
Fax: 405-478-1044
Date:___________________
Note: While application does not guarantee placement / training, no answer will disqualify you.
Please fill in all answers.
Applicant (person with whom the dog will be working):
Name:__________________________________________________
Age:_____________ Sex:_______ Date of birth:________________
If applicant is minor or dependant, who will be responsible for the dog's medical / food bills and oversee its care and grooming (or expenses if you choose a reputable groomer?)
Name:___________________________
Relation to Applicant:_________________
Person to whom correspondence should be sent:
(Please circle) Mr. or Ms. ___________________________________
Address:_____________________________________________
_______________________________________________________
Street City State Zip
Fax (if available):____________________
E-mail (if available):__________________
Phone (include area code): ____________
First and last name of person we can converse with over the phone or TDD about this application:
___________________________________________________
_____________________________________________
Home Phone: (____)____________Voice, TDD, either,
or other?______Hours:______
Work Phone: (____)_____________Voice, TDD, either,
or other?______Hours:_____
Do you need application in ASL? __ Yes __ No
Do you already own a dog? Y N
If yes, do you think it could be your hearing dog? Y N
Why?_________________________________________
_______________________________________________
Would you like to make an appointment to have your dog tested to see if it can be your hearing dog? Y___ N___
Print this REQUEST for an application out and make an extra copy for yourself. Then, fill it out and mail/fax it to us. Make sure you send the application addressed to "Dog Ears".
We will contact you as soon as possible. |
