Pets for Vets / PAWSitive Therapy Troupe Application

You and your dog MUST be currently registered Delta Pet Partners in order to apply for membership in the Pets for Vets / PAWSitive Therapy Troupe.

I understand that membership in the Pets for Vets / PAWSitive Therapy Troupe means that I agree to participate in at least one therapy visit per month. I also assert, that, to the best of my knowledge, my dog is not aggressive to humans or other dogs, and has never bitten a person.

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.