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Get Hearing Dog Application

Because of the high demand for these dogs, we must give priority to those applications who demonstrate the most need for a working dog. Our Hearing Dogs are placed with residents of California only. Please print and mail this completed application to: The Sam Simon Foundation Assistance Dogs Program, 30765 Pacific Coast Hwy, #113, Malibu, CA 90265 ALL INFORMATION YOU SHARE WILL BE KEPT CONFIDENTIAL Name: Date Street Address: Mailing Address (if different) Home Phone Cell Phone Work Phone.

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