Dogs With Wings Applicant Information Form

We are only able to place dogs with persons resident in the Province of Alberta.

Applicant's Name: (firstName lastName)
(*)Family or Parents Name: (if applicant is a minor, firstName lastName)
Applicant's Date of Birth:
Address:
(*)City:
(*)Province:	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal Code:
(*)Phone Number:
Email:
(*)Indicate type of Dog:	Guide Dog Service Dog Autism Dog Facility Dog Companion Dog
Notes:

*The information collected here is confidential and for DWW staff only*