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Dogwise.com All Things Dog!

IMPORTANT: PLEASE FILL OUT THIS APPLICATION COMPLETELY AFTER READING THE NOTES AT THE BOTTOM OF THIS FORM.

Contact Information
Name: 
Email: 
Street Address: 
City: 
State:    ZIP: 
Home Phone:  (
Work Phone:  (
How did you learn about Pets for Vets / PAWSitive Therapy Troupe? 
Educational Background: 
Employment Experience: 
Previous Volunteer Experience: 
Dog Information
Dog's Name: 
Breed: 
Birth Date: (mm/dd/yy)  / /
Sex:  Male   Female
Spayed / Neutered?  Yes   No
Did you adopt or purchase your dog?  Adopt   Purchase
From where? 
Delta Registration Number:
Expiration Date:
Vet's name: 
Street Address: 
City: 
State:    ZIP: 
Describe the training classes that you and your dog have completed:
Titles Earned in Competition?  Yes   No
Has your dog competed for titles in: 
Obedience
Agility
Flyball
Hunting
Tracking
Herding
Where have you and your dog visited as Delta Pet Partners in the past?
Does your dog have any medical condition(s) that would impact therapy visits? If yes, describe If yes, please describe:
Does your dog have any food allergies? 
Yes   No
If yes, please list:
Are there any types of people that your dog does not do well with? If yes, describe
Yes   No
If yes, please describe:
Is your dog reactive when other dogs are nearby? If yes, describe the behavior and how you deal with it.
Yes   No
If yes, please describe:
Which of the following areas are you and your dog interested in visiting as members of the PAWSItive Therapy Troupe?
Hospitals
Nursing Homes
Schools
Children's Advocacy Room Programs
Release Statement: I hereby certify that, if accepted as a volunteer into this program, I will keep my dog’s vaccinations, fecal testing, and heartworm prevention treatments current, and will provide proof of such vaccinations, tests results, and treatments on a yearly basis to the program coordinator.  I also agree to keep my dog’s Delta Pet Partner registration current and provide proof of such registration whenever my dog is retested. 

 

PPDT, Inc. requires all class participants to abide by our house rules and sign a liability release and indemnification agreement prior to the start of classes (both documents require Adobe Acrobat Reader).