Inquiry About Facility Dog Placement

First Name:

Last Name:

Phone:

Address:

City:

State:

Zip:

Email:

Verify Email:

Occupation:

Gender:

MaleFemale

How did you hear about Paws’itive Teams?:

Please describe your facility and the client population served:

What is your position at the facility and the ways you are involved directly with the clients:

How long have you worked at this facility?:

Describe your reasons for wanting a Facility Dog:

Describe your typical day at work.

How do you expect working with and having a Facility Dog living with you will affect your life?:

Describe other members in your home:

Are you or other members living in your household allergic to animals? Please explain:

Select your home type: house apartment condo mobile home

Select your yard type: unfenced yard patio fenced yard no yard

Do you or any household member have a dog, other pets or other critters that a dog will need to get along with? Describe:

Describe your past relationships with dogs and any experience you have had in training your own or other dogs:

If you have a dog now, where does that dog sleep?:

Have you participated in dog shows, pet therapy or other dog related activities? Describe:

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