Paws’itive Teams
Voice:(858) 279-7297
Fax:(858) 279-7296
paws@pawsteams.org
San Diego, CA

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(Running or not!)

Therapy Dog Program Application

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).

Certification with Paws'itive Teams Therapy Dog Programs only applies during 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 restrictions.

*Preliminary Information*
I have read the information at the top of this form and understand that liability insurance related to Paws'itive Teams certified therapy dog teams only covers sponsored activities of this organization.

Yes No

I am interested in the PAAT Program, working with health care or educational professionals in a goal-directed setting.

Yes No

If yes, please indicate which site(s) interest you. (Note: read Site description for list of sites)

I am interested in Personal Paws, working with an individual client on an on-going basis in the home setting

Yes No

If yes, please indicate what geographic areas of the county would be convenient

I am available to volunteer during the following times/days. Please describe your availability.

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:

Do you belong to any clubs or organizations?

Yes No

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)?

Yes No

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)?

Yes No

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

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

Yes No

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?

Yes No

Dog’s City License Current?

Yes No

What is the dog's license number:

Behavioral Information
Has your dog ever bitten another dog?

If so, please explain:

Does your dog sleep inside at night?

Yes No

Is your dog housebroken?

Yes No

Does your dog signal to go outside?

Yes No

Does your dog toilet on command?

Yes No

Does your dog behave while being bathed?

Yes No

Is your dog allowed on the furniture at home?

Yes No

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.

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 have any consistent annoying behaviors you would like to change? Please describe

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?

Yes No

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 :

Words and Music for: "Together We're Better" © 2006 Marilyn Davis. All rights reserved.
Unauthorized duplication is a violation of applicable laws.
Website © 2006 San Diego Photographer, Balance Digital, Pawsitive Teams.