My Canine Companion Autism Service Dog - Expression of Interest

Our waiting list is now closed.

Please express interest in our waiting list, by filling out your details on the form below.

You will be placed on our mailing list and will receive information by email about any future list openings.

Please fill out your details below

Caregiver's Name

First Name

Last Name

Phone

(###)

###

####

Address 1

Address 2

County

Eircode

Child/Young adults name

Child/ Young adult's Date of Birth (dd/mm/yyyyy)

Diagnosis

*Proof of an ASD Diagnosis will be required on successful application

Can My Canine Companion add you to our mailing list for future volunteer opportunities?

This may include fundraising activities eg bag packs or flag days, volunteer opportunities eg puppy raising/boarding