Application *

By signing this application, you are committing to do the utmost to care for your emotional support animal. If you need assistance with food or veterinary expenses, or at any time can no longer care for or keep the animal in your residence, you will contact the Mill Creek Community Lions by email or text/call to the contact points provided above for support with the matter.

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Pet History *

Have You Ever Had a Dog?

Yes

No

Living Situation *

Do you live in a home/apartment currently that allows dogs?

Yes

No

Fenced Yard *

Do you have a fenced in yard or able to walk your dog on a leash to provide daily exercise? (this can include dog parks if you don’t have a fence at your residence)

Yes

No

Digital Signature *

By signing this application, you are committing to do the utmost to care for your emotional support animal. If you need assistance with food or veterinary expenses, or at any time can no longer care for or keep the animal in your residence, you will contact the Mill Creek Community Lions by email or text/call to the contact points provided above for support with the matter.

First Name

Last Name