Welcome Canine-Assisted Therapy Volunteer Applicants

Thank you for your interest in canine-assisted therapy. Please fill in all the information completely before going on to Part 2:

Your Name
Dog's Name

Address
City
State
Zip

Email

Home Phone
Work Phone
Cell Phone

The following YES or NO questions are designed to help you evaluate whether or not you and your dog would be a suitable Therapaws team:

1. Are you 16 years of age or older? YES NO
2. Is your dog one year of age or older? YES NO
3. Therapaws and Therapy Dogs Incorporated (TDInc.) require the handler to be the owner of the dog that will participate in our program. Do you own the dog that you want us to consider for Therapaws? YES NO
4. The Screening-Testing process can take up to six months. All qualified teams are encouraged to commit to regular, assigned visits for a period of at least two years. Are you able to make this time commitment? YES NO
5. Therapaws teams (owner and dog) make regularly scheduled visits to hospitals and extended care facilities in Ann Arbor and surrounding communities. Are you able to make regularly scheduled visits within our service area? YES NO
6. Therapaws teams generally travel by car to their placement. Does your dog ride well in a car and do you have reliable transportation to make regularly scheduled visits? YES NO
7. Most facilities require staff to be on site during our visits. Therefore, most of our team visits are scheduled during weekdays. Evening and weekend assignments are rare. Are you available to volunteer for assignments Mondays through Fridays between 9 A.M. and 5 P.M.? YES NO
8. Therapaws dogs must be current on all required vaccinations and must have an annual veterinary physical examination and fecal test. Can you meet this requirement? YES NO
9. Therapy dogs must have some level of obedience training and must meet certain temperament standards. These include being able to walk on leash without pulling, following basic commands, willing to be touched by strangers, responding calmly to people calling name, tolerating sudden noises such as voices, approaching wheelchairs, walkers, canes, etc. Can your dog meet these requirements? YES NO
10. During visits, therapy dogs sometimes meet up with children and adults who may suddenly grab, poke, or pull on them. Would your dog react to such behavior with aggression or submissive piddling? YES NO
11. Occasionally dogs will come in contact with other dogs or animals during a visit. Does your dog show signs of aggression toward other animals or people? YES NO
12. Therapy dogs are expected to show up for a visit with a clean, brushed, odorless coat, clean teeth, clear eyes, and trimmed nails. Dogs must be free of external parasites and any insecticide treatment must be administered not less than three days in advance of a visit. Can you meet these requirements? YES NO
13. Dog owners must be neat, well groomed, sociable, and willing to follow and respect the facility's standards, rules, and procedures. Can you meet these requirements? YES NO
14. Do you consider yourself compassionate, friendly, dependable, and one who maintains good judgment when interacting with others, like extending empathy but not sympathy? YES NO
15. In your dealings with patients or residents, can you be a good listener while maintaining strict confidentiality? YES NO
16. Your overall health is important. Do you have any conditions that would prevent you from making and completing regularly scheduled visits? YES NO
17. Are you comfortable interacting with sick children or with people who may be very ill, suffering from dementia, disfigured? YES NO
18. Registration by Therapy Dogs Incorporated (TDInc.) does not allow you to take your dog to work. You must be actively volunteering to be in any facility with your dog. Do you agree to abide by this rule? YES NO

If you feel you and your dog will make a good Therapaws team after answering the questions above, please go on to Part 3.

Occupation

Previous volunteer experience(s)

Why would you like to be involved in this program?

What type of facility would you prefer to visit and one where your dog's
temperament would be suitable?

What is your preferred frequency of visits? --- Choose one --- Weekly Biweekly Monthly Bimonthly

What is your preferred day(s) to visit? --- Choose one --- Monday Tuesday Wednesday Thursday Friday

What is your preferred time to visit? --- Choose one --- Morning Afternoon

Call name

Breed (If mixed, give details)

Color(s)/marking(s)

Sex --- Choose one --- Male Female

Spayed or neutered?YES NO

Date of birth (approx.)

How long have you owned your dog?

Approx. dog age when you adopted

Obedience training (describe classes, level, home training, etc.)

Describe exposure of dog to new and unfamiliar places

Tell briefly why your dog would make a good therapy dog