Register for our workshops today

A. Parent Details

Title:MrMrsMissMsOther

First name*

Surname*

Current address*

Postcode*

Home phone

Mobile phone

Email address*

B. Child Details

First name*

Surname*

Age*

Date of birth*

State the full clinical diagnosis of your child*

Date of Diagnosis*

What is your child’s main method of communication?

 Verbal Non-Verbal

What sensitivities affect your child?

 Sound Smell Light Touch Taste Other

If you clicked "Other", please specify:

Please list all members of the household and state their relation to the child

Are there any siblings within the household on the autistic spectrum?

Please list any sources of support to you and your family - e.g. family, friends or organisations

Do you currently own a pet dog?
If yes, please complete Section C

 Yes No

Do you or a member of the family currently own any other pets?
If yes, please state what pets:

Does any member of the family have any allergies to animals?
If yes, please give details:

C. Dog Details

Name

Breed

Age of Dog

 0-6 months 7 months - 2 years 2-6 years 6+ years

Period of ownership

Where did you obtain your dog?

 Newspaper Advert Breeder Rescue Centre Friend/Family Assistance Dog Centre

Coat Type - e.g. long, short, wirey

Prior training experience - e.g. puppy classes, agility, obedience training by yourself

Has your dog ever displayed signs of aggression, if so how? - e.g. towards other animals, towards other people

Briefly explain why your dog is trainable within the PAWS project

D. Declaration

The details that we ask for help to ensure that we provide parents with the most suitable service. Only relevant information will be held on the Training Department’s files in accordance with the terms of the Data Protection Act 1998 and Dogs for the Disabled will be the data controller for the purposes of the Act. If you want to know more about the information we are holding, or the way we use it then you can write requesting details to: The Data Controller, Dogs for the Disabled, The Frances Hay Centre, Blacklocks Hill, Banbury, Oxon. OX17 2BS.

Please read the following information carefully and sign to confirm that you understand, and are willing to be bound by the terms and conditions.

The PAWS Project is a different and separate service from the Autism Assistance Dog Service also offered by Dogs for the Disabled, which results in children being partnered with a highly trained full Assistance Dog with public access rights.

A vital part of our work is to carry out research over the next three years into why dogs affect children with autism and the impact on the family as a whole. We have partnered with the National Autistic Society and the University of Lincoln to carry out this research. Some families will be required to contribute information over the course of the three years via the web and telephone and home interviews. Some filming will also be necessary. The results of the research will be available at the end of the three year period, and we will let you know where the research will be published. No personal details will be included in the research, so participants will remain anonymous in the published findings.

• I confirm that I have read and understood the eligibility criteria
• I confirm that to the best of my knowledge, the information I have provided is full and accurate.
• I confirm that I understand that taking part in the PAWS Project will not result in my pet dog gaining public access rights or assistance dog status i.e. entry into shopping centres etc.
• I confirm that I am willing to be contacted about contributing information over the period of three years to the research project, including telephone and home interviews, online and filming.

You will receive communications from us relating to the PAWS project. We'd also like to keep you updated on Dogs for the Disabled's general activities. If you do not wish to receive these communications, please tick the following boxes
 Email Mailing

To provide further information to families and professionals interested in the PAWS Project, we may take photographs at our workshops. Dogs for the Disabled may use official photographs of PAWS workshop attendees to highlight its work in the media, via its website and in marketing materials produced by the charity.

I consent to my involvement in official Dogs for the Disabled photography, film or video being used for highlighting the charity’s work. 

I confirm I have read the above and am willing to be bound by the terms and conditions*