Residential L.E.A.P. Program
Residential Life Enrichment & Acclimation Program - Free (w/ Approved Application)
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Residential LEAP Program Application

Rescue Information:

Rescue or Shelter Name

Address

Phone

Contact Name

Rescue/Shelter Website

Dog Information:

Dog Name

Breed

Age

Sex

Male

Female

Spayed/Neutered

Yes

Location

Current Length of Stay

Reason for Surrender - How Dog Acquired by Rescue/Shelter

Any Known Sensitivities or Allergies (food or otherwise)?

Any Known Medical Conditions (be specific)?

Any Medications, Preventatives or Supplements (be specific)?

UTD on all vaccines

Yes

Vet Exam within last 6 months

Yes

Has Dog Lived in a Home Prior?

Reactivity to:

Behavior On Leash

Any Known Triggers

Bite History - Bites to Humans (if yes be very specific)

Bite History - Bites to Animals (if yes be very specific)

Any prior training or work that has been done by rescue/shelter (be specific)?

Reason for Requesting LEAP Program - Why is this dog a good candidate?

Goals & Expectations - What does success look like to you?

Agreement & Acknowledgment

By signing below, I understand and agree that:

Submission of this application does not guarantee acceptance into the Residential LEAP Program.
The Residential LEAP Program is offered at no financial cost to the selected rescue/shelter.
LEAP is offered only a limited number of times per year and accepts very few dogs.
The rescue/shelter remains the legal owner of the dog during the program.
The rescue/shelter is financially responsible for all veterinary expenses, including any emergency care, during the dog’s stay.
Full disclosure of medical and behavioral history is required.
LEAP is a structured residential learning program and specific behavioral outcomes cannot be guaranteed. This is not obedience training.
UpSwing Canine Behavioral Services will implement training, management, and safety protocols deemed appropriate for the dog’s welfare and program integrity.

Signature

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