Application

Volunteer Commitment:

I understand that if I am certified as a Pets for Vets / PAWSitive Therapy Troupe volunteer, I will participate in at least one therapy visit every three months. I also assert that, to the best of my knowledge, my dog is not aggressive towards humans or other dogs.

Contact Information
Name:
Email:
Street Address:
City:
State:	ZIP:
Home Phone:	()
Work Phone:	()
How did you learn about Pets for Vets / PAWSitive Therapy Troupe?
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?
Vet's name:
Street Address:
City:
State:	ZIP:
Describe the level of obedience that your dog has achieved:
Does your dog have any agility training?	Yes  No
Has your dog competed for titles in:	Obedience Agility Flyball Hunting Tracking Herding
Does your dog get along with: Y N Babies / toddlers? Preschool age children? School age children? Men? The elderly? Other dogs? Is your dog reliable on a sit / stay or down / stay under distracting conditions? Will your dog walk on a loose leash without pulling? Does your dog jump up on you? Does your dog jump up on other people? Is your dog under reliable control off-leash? Does your dog take treats gently?
Which of the following personality traits best describe your dog? (check as many as apply)	Adaptable Outgoing Shy Nervous Friendly Excitable Calm Reliable Noisy Very interested in other dogs
Please list any special tricks that your dog can do:
Please list any medical conditions that we should be aware of:
Does your dog have any food allergies?  Yes  No	If yes, please list:
Human Questions:
Past educational experience:
Past work experience:
Do you have any previous volunteer experience?  Yes  No	If yes, please describe:
Do you have any experience interacting with hospitalized patients?  Yes  No	If yes, please describe:
Do you have any experience interacting with physically and / or mentally challenged people?  Yes  No	If yes, please describe:
Please check the Pets for Vets/ PAWSitive Therapy Troupe therapy visits that you are interested in: (Multiple areas of interest may be chosen)	Hines VA Hospital Loyola Hospital Fairview Baptist Home Franciscan Sisters Infirmary Alden Nursing Home
Release Statement: I hereby certify that, if accepted as a volunteer in this program, I will keep my dog's vaccinations, fecal tests and heartworm treatments current, and will provide proof of such vaccinations, tests and treatments on a yearly basis to the program coordinator. I also agree to keep my dog's therapy dog certification current, submitting yearly registration fees and/or recertification testing as required to the national organization which certifies my dog. I will also give copies of my dog's certification to the program coordinator on a yearly basis.