Paws’itive Teams
Voice:(858) 674-0845
Fax:(858) 674-7461
paws@pawsteams.org
San Diego, CA

Your donation can help change lives!

PAAT Program Application

(Paws'itive Animal Assisted Therapy Program)

The person who will visit with the dog must complete this form. If you are not the owner, you must provide written proof of permission to handle this dog.

After completing the entire form, click on the SUBMIT button (at the end).

PAAT Certification only certifies you to be involved with the PAAT Program and Paws'itive Teams sponsored activities. The liability insurance will not cover you during any other therapy related programs or activities. Please indicate YES or NO that you understand these retrictions.

Before completing this application, please note that we are only considering certification for new teams available and interested in volunteering with our current sites. However, if you aren't available for any of these programs but are still interested in consideration for our goal directed program, we will keep your application in our files and notify you when we launch new sites. Please complete the first two preliminary statements before proceeding with the application:

*Preliminary Information*
I have read the description of the current sites and would be interested in volunteering with one of these sites.

Please indicates which site(s) you are interested in:

I am not available at this time for any of the current sites but would like to be considered for a future opportunity. (Give details as to the type of programs that interest you and limitations as to location or times of the day for volunteering.)

Applicant Information
Owner’s Info:

First Name:

Last Name:

Handler’s Info:

First Name:

Last Name:

Street Address:

City and Zip:

Home Telephone:

Mobile Telephone:

E-Mail Address:

Verify E-Mail Address:

Emergency Contact:

Emergency contact phone:

Handler's education: Please tell us a little about your educational background. Include any relevant training, vocational schools, workshops, etc. Indicate Emphasis and/or Major:

Employment: Enter information about your employment history starting with your current or most recent job and include a description of your duties and length of time with that employer/position:

References: Please give us the names of two personal or business contacts who can act as references on your behalf (no family members). Include person's name, daytime number and relationship.

Reference #1 Name:

Phone:

Relationship:

Reference #2 Name:

Phone:

Relationship:

List the days and times you are available for volunteering:

Do you belong to any clubs or organizations?

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

Where/how did you acquire your dog companion?

How long have you had or known this dog?

What training has your dog had?

Do you train with Operant Conditioning methods (i.e. positive reinforcement & clicker training)?

List the major 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)?

Are there any environments that your dog avoids or may cause stress?

Are you and your dog certified with any therapy dog organizations?

If yes, please give details and name of organization(s):

Dog Information
Dog’s Name:

Dog’s Age:

Date of Birth:

Breed/Description:

Gender:

Spayed or Neutered?

Dog’s City License Current?

What is the dog's license number:

Behavioral Information
Has your dog ever bitten anther dog?

If so, please explain:

Does your dog sleep inside at night?

Is your dog housebroken?

Does your dog signal to go outside?

Does your dog toilet on command?

Does your dog behave while being bathed?

Is your dog allowed on the furniture at home?

Why do you think your dog would be good for this program?

Are you an alumni of the Paws'itive Teams Prep School? How long ago did you take the class?

If not, describe you and your dog's experiences in therapy volunteering.

What type of facilities do you want to visit (hospital, nursing home, school, etc)?

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

How do you praise/reward your dog?

Does your dog lick people? If so, describe how you encourage or discourage the behavior?

Does the dog pull while on the leash?

Does the dog get into the trash at home?

List any outstanding behaviors that your dog does well (e.g. tricks, accomplishments, different habits):

How does your dog react around other dogs? Please elaborate on any incidents which include any of the following: growling, snapping, snarling, excessive barking at, lunging towards, or biting. Were incidents on or off leash?

Has your dog ever acted in a threatening or menacing manner towards an individual or group of individuals? Threatening/menacing includes overt staring, growling, snapping, snarling, barking at, lunging toward or biting an individual. Describe below:

How did you respond?

Is your dog currently working as a therapy dog?

If yes, please give details and name of program if certified:

Are there any specific age groups that your dog avoids or seems uncomfortable around (i.e. Infants, Adult Women, Adolescents, Adult Men, School Age children, Toddlers, Seniors, Other?) List all that apply and briefly describe below:

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

What is your dog's favorite games or activities?

How do you discipline or correct your dog?

What does your dog do when he/she becomes stressed? What do you do when you recognize signs of stress in your dog?

Describe why you are interested in volunteering and what you hope to get out of it:

Thank You for your interest in our program!

DECLARATION: To the best of my knowledge and belief, all the statements made above are true and complete. I understand that submitting this form will serve as my electronic signature.

Please retype this code below :