Name *

First Name

Last Name

Phone

(###)

###

####

Tell us about your dog *

check all that apply

Is one year of age or older (required)

Has attended a 6-week obedience training course* or equivalent private training (required) *Puppy classes do not count

Is in good health and able to be active for 1-2 hours at a time

Is non-aggressive/non-reactive to people and other dogs

Tell us about you *

Check all that apply. I can/will...

Commit a minimum of one hour per month, but up to once a week, volunteering in a program at a set time frame (e.g. Wednesdays from 6:30 – 7:30 p.m.)

Be reliable and consistently on time

Be proactive in fulfilling onboarding requirements and signing up for events and programs

Maintain my dog’s skill level throughout the duration of his/her service

Participate in programs in which my dog will actively be working with and commanded by participants (not needed for Orange Team/Visitation assignments)

Check and read electronic correspondence

Which certification would you like to take? *

check one

Goal-Directed

Visitation

Does your dog have their Canine Good Citizen title? *

Yes

No

May Canine Therapy Corps add you to its email distribution list? *

Yes

No