Receive Support

Hannah's Heart Application

Information:

Please apply for the Hannah's Heart assistance program by answering the questions below. This application is step ONE of TWO. Please understand that to be considered for a puppy, both portions of the application must be completed. Thank you for understanding and more importantly, thank you for applying.

Hannah's Heart does not provide service training for your dog if you are accepted, as we feel it is important for the client and dog to build relationship together as a team. One of our volunteers will assist in locating a qualified trainer in your area to assist you with your training goals.

1. Application
Start by completing an application and submitting it to us. After you have submitted your application, you will receive an email with a copy of your application and instructions to complete the next step- email us a video submission (a link to a video uploaded to Youtube or Vimeo, etc)telling us your story and how this dog can change or save your life or the life of the person you are nominating. The video must be completed as the second half of your application.

Eligibility:

In order to qualify for this service, the nominated child/applicant's child must:

-Have a diagnosed disability and letter from their doctor.

-Reside in the United States

-Have no more than two current dogs at the residence

-Understand that a Kids Companion Dog is NOT a service animal. It is not trained to mitigate a disability or perform tasks. It is recognized as a Skilled Companion and has no public access rights under the ADA.

Costs:

Our program is run fully on donations, and we provide adoption assistance based on availability of funds. Families approved will be able to adopt a puppy at a reduced rate, dependent on the available donations.

First Name

Last Name

Phone Number I would like to receive text notifications.

Name and DOB of who this puppy is intended for?

Are you or the person you are nominating able to do puppy training? The puppy will come home for you to establish a bond. We offer assistance if needed in locating a trainer in your area for additional training.

Share with us how a Habibi Bear can provide relief for the applicant/nominated person?

Does your child want a support puppy? Why? (in the child's own words)

Are you able to afford annual dog supplies and medical care?

YesNo

Do you own or rent your home?

RentOwn

Type of Home?

Apartment/CondoHouse

Is your yard fenced?

Do you have any pets in the home? Type, name, sex, ages:

Is there any other information you would like to share to help us in processing your application?

Your Full Name

Signature

Clear

Today's Date

Hannah's Heart Application

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