Therapy Dog Team Application

THANK YOU IN ADVANCE FOR YOUR TIME AND INTEREST IN OUR PROGRAM!

Our Certification only certifies you to be involved with the Paws Of Love Program and sponsored activities and is not transferable to other programs.

Please indicate that you understand these restrictions. *

Yes

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Mobile Phone *

Home Phone (if different)

Email Address *

Emergency Contact Name *

Emergency Contact Phone *

Please tell us about any relevant training, vocational schools, workshops, etc.

Reference Name * 🛈

Reference Relationship *

Reference Phone *

What type of facilities interest you most to visit? *

With what age group do you believe you and your dog would be most effective? *

Children (5-12)	Youth (13-18)
Young Adults (18-23)	Seniors (50 and over)

Do you currently belong to any clubs or organizations? *

Yes

If Yes, please list

What organizations do you currently volunteer for or have volunteered for in the past?

Why do you want to participate in this program? *

DOG INFORMATION

Dogs Name *

Dogs Age *

Dogs Breed *

Dogs Weight *

Dogs Gender *

Male

Female

Spay/Neutered *

Yes

License Current *

Yes

What City is Dog Licensed in? *

Where/how did you acquire your dog companion? *

How long have you had this dog? *

DOG BEHAVIORAL INFORMATION

What training has your dog had? *

Do you train with Positive Reinforcement? *

Yes

List the commands your dog responds to: *

Has your dog ever been encouraged or trained to bite, even as part of a dog sport (e.g. Schutzhund)? *

Yes

Has your dog ever bitten a human or another dog? *

Yes

If Yes, please explain:

How does your dog react around other dogs? *

Has your dog ever acted in a threatening or menacing manner towards anyone/thing? *

Yes

If Yes, please explain?

Does your dog lick people? *

Yes

If so, describe how you encourage or discourage the behavior?

What does your dog do when he/she becomes stressed? *

What do you do when you recognize signs of stress in your dog? *

Is your dog housebroken? *

Yes

Does your dog signal to go outside? *

Yes

Does your dog toilet on command? *

Yes

Does your dog get into the trash? *

Yes

Does your dog sleep inside at night? *

Yes

Does your dog pull on leash? *

Yes

Are there any specific animals that your dog does not react well with?

What are your dog's favorite games or activities?

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