Responsible Ownership Application General InformationHow did you hear about the ROP Course?(Required) Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Number of Adults in the home(Required) Number of children in the home(Required) Include age(s)Any other animals in the home?(Required) Not including applying canine.Canine InformationName(Required) Breed(Required) Age(Required) Weight(Required) Main Color(Required) Tag # & Micro Chip(Required) Incident HistoryNumber of bites/incidents that resulted in local animal control being called.(Required) Bites/Incidents involving humans(Required) Please explain each inccident with a human(Required) N/A if not applicableAge (s) of humans(Required) Did the incident/bite require medical visits?(Required)YesNoNumber of Bites/incidents involving other animals(Required) Please explain each incident with an animal(Required) N/A if there is no historyRequired Vet care?(Required)YesNoRequired Vet Care?(Required) History of CanineWhat is the training history of your canine?(Required) List class type and location of training School (s) for classes taken with the canine .(Required) Does the Dog have any formal titles or awards? (not graduation certificates from classes) such as CGC or obedience titles.(Required) Briefly describe the canine's health.(Required) Any medications?(Required) Any medical issues? (i.e. hips, eye, elbows, knees, heart, etc.)(Required) Please explain why you feel that you and your canine are a good fit for this course.(Required)Things we will need from you(Required) Police Report of Incident Letters from Vet, Trainers, Family Members, Friends, & anyone who can cite positive interactions with your dog Letter from you, stating what you have learned after incident Vet Records Current Registration Training Evaluation Training Plan Select AllConfidentiality Agreement, Disclosure, Authorization to Release Records(Required)Max. file size: 5 MB.Police Report(Required)Max. file size: 5 MB.Letters(Required) Drop files here or Select files Max. file size: 5 MB. Current Registration(Required)Max. file size: 5 MB.Vet Records(Required)Max. file size: 5 MB.Training Evaluation(Required)Max. file size: 5 MB.Training Plan(Required)Max. file size: 5 MB.Upload photo of canine(Required)Accepted file types: jpg, jpeg, png, gif.hCaptcha(Required)
