Application

NEADS Service Dog for a Child with Autism or Other Developmental Disabilities

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  = Required Information

Contact Information

Welcome to the NEADS Service Dog for Children application. We are looking forward to learning more about you. If you have any questions, please contact Katy Ostroff at 978-563-1516
**A child must be 8 years of age or older at the time of application. All Service Dogs are Labrador Retrievers.**
Child's First Name
Child's Last name
Guardian's First Name
Guardian's Last Name
Guardian's Relationship to Child

Address

Street Address
City
State
Zip Code

Phone & Email

Phone Number
Email (Required)
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