ASD Registry™ - American Service Dogs™ | Registration Application 2024
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This form is designed to provide a streamlined method for you to apply for registration of
your Service Dog (SD) / Psychiatric Service Dog (PSD).


If approved, you will receive your notification and details within 30 working days following approval.

Please complete all required fields and ensure that the Handler Photo and Dog Photo are uploaded. Expect this entry to take 30 minutes or more to complete.


* = Required Information

2405300752
Registration date: 2024-05-30
tRegistration date: 2024-05-30
Start Date: 2024-05-30
tStart Date: 2024-05-30
Expiration Date: 2025-05-30
tExpiration Date: 2025-05-30
REGISTRATION INFORMATION
 
*Service Dog Type:
*Application Purpose:

DOG/HANDLER IMAGE VERIFICATION INFORMATION
 
"Upload a headshot image of your dog and handler here.
Each image size should be no greater than 250px x 250px"


*Handler Portrait Image Filename
(From Local Computer/Device):



    

 
*Dog Portrait Image Filename
(From Local Computer/Device):

    

 
HANDLER INFORMATION
 
*Handler Name:
*Handler Main Phone Number:
Mobile Number:
 
HANDLER ADDRESS
 
Street: 

City:
 
ACCOUNT INFORMATION
 
 
 
DOG INFORMATION
 
 
Dog Birth Date (YYYY-MM-DD): 
Dog Birth City: 
Dog Birth State: 

*Spayed / Neutered:
AKC Registered:    AKC Registration Number: 
 
*Services / Actions Dog Is Trained For:
( Be specific in details of what your Service Dog has been trained to do )
 
GENERAL INFORMATION
 
      
   Veterinarian Phone Number:    
 
:
  :
:
:
 
:
 
SECURITY AGREEMENT
 
Security Image

*Please enter the characters you see above:  




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