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Therapy Animal
Application Form

Paws for Life USA Client Application

FOR A THERAPY DOG

Paws for Life USA will keep your entire application confidential. Your written application will become the property of Paw for Life USA

Please review the application instructions before completing this form. Your application will be reviewed and an interview scheduled when all information has been received.

Part A - Client Application, completed by client, two letters of recommendation and a $25.00 application fee. Please attach recent Rabies and Medical Records by your veterinarian. Please fill out the following application so we can get to know you a little better. Is your dog child-friendly, respectful, under verbal control and reliable? Are you community-minded and empathetic - and do you have time to volunteer on a regular basis if using PFLUSA facilities or wish to obtain one of Paws for Life USA dogs? If you and / or your dog answer yes, please complete our therapy application below.

Today's Date
Month
Day
Year
Birthday
Month
Day
Year
Sex
Male
Female
Multi-line address

Military Personnel Only:

Do you have a military affiliation?
Yes
No

Please select from the following the type of Therapy you are interested in participating in:
Therapy Dog
Animal Assisted Therapy Dog

Therapy Dog is the most widely used method of animal therapy. These dogs are trained household companions that together with their handler visit nursing homes, hospitals, retirement homes plus many other facilities to over comfort and joy that can reach beyond traditional forms of healing and medical treatment.

Animal Assisted Therapy Dog assist physical and occupational therapists in meeting specific goals or "measured results" important to a patient's recovery. These dogs are used to help anyone suffering from a stroke, physical injury, or trauma. AAT (animal-assisted therapy) dogs and their volunteer handler team up with trained therapists to use agility equipment and recreational therapy techniques. The end result encourages a patient to regain mobility, strength, range of motion, balance and confidence.

Do you speak a foreign language?
Yes
No
Do you know sign language?
Yes
No

Tell Us About Your Dog

Dog Gender
Male
Female
Spayed - Neutered?
Yes
No

Behavior Questions

Does your dog understand hand signals?
Yes
No
Does your dog get along with people?
Yes
No
Does your dog get along with other dogs?
Yes
No
Is your dog shy/nervous around large crowds?
Yes
No
Do you consider your dog reliable on "sit/stay" and "down/stay" commands in distracting conditions?
Yes
No
Is your dog under reliable control off-lead?
Yes
No
Has your dog had formal obedience training?
Yes
No
Availability

Preferred Locations

Preferred Visit(s)

Will it be difficult for you?

To attend group classes at the PFL USA Training Center for an hour to hour and a half one day a week for 4 - 6 week sessions?
Yes
No
To attend private Obedience Classes?
Yes
No
That you and your dog are ambassadors for Paws for Life USA, as well as for the entire therapy dog industry and you will be expected to maintain your dog’s appearance and manners, as well as your handling skills.
Yes
No

You must maintain identification for public access, if applicable.

That you assume full responsibility for maintaining appropriate training and behavior, and every two years updating your Canine Good Citizen certification as applicable with Paws for Life USA.
Yes
No
That you must assume full responsibility for cleaning up after your dog eliminates in public and for repairing any damage caused by your dog
Yes
No

Sign below if you agree to the conditions listed above. Attach additional sheets if needed to explain any ‘No’ answer.

Date
Month
Day
Year

Letters of Recommendation and Veterinarian’s Information

Please list the name and contact information of two people who will provide letters of recommendation for you.

1.) Personal (not a relative),

2.) Professional (Veterinarian).

Please send letters of recommendation to:

Paws for Life USA

P.O. Box 72016

Marietta GA 30007-2016

Fax 770-579-8289

admin@pawsforlifeusa.org

Please ask your veterinarian to provide you with latest medical records, rabies certificate, fecal and heartworm / flea tick records for you to attach to this application.

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