Canine Therapy Corps - Animal Assisted Therapy

Part One - Tell us About Yourself

First Name*
Last Name*
Street Address*
Apt. or Suite
City*
State*
Zip*
Home Phone
Work Phone
Mobile Phone
Fax
Email Address*
Foreign Languages
Sign Language No    Yes

How would you like to help Canine Therapy Corps?* (check all that interest you)
Volunteer in a program with a dog
Volunteer in a program without a dog
Administrative Support (mailings, help in the office)
Help recruit volunteers, plan volunteer activities
Marketing, Public Relations
Fundraising, Special Events
On-site Program Observation and Evaluation
Newsletter and/or Website Production

How did you hear about us and why do you want to work with us?*


Tell us about your prior volunteer experiences. Do you have any experience in working with disabled persons?*


Please comment here if you have any additional comments, questions or suggestions regarding the application:

Part Two - Tell Us About Your Dog
(Skip this if you did not select "Volunteer in a program with a dog")

Dog's Name
Dog Breed
Dog Gender   Male Female
Dog Birth Date (mm/dd/yyyy)
Spayed/Neutered Yes    No
Veterinarian Name
Vet Address
Vet City
Vet State
Vet Zip


Vet Phone

Behavior Questions

Does your dog understand hand signals?
Yes    No

Does your dog get along with people? 
Yes     No

Does your dog get along with other dogs?
Yes     No

Is your dog shy/nervous around large crowds?
Yes     No

Do you consider your dog reliable on "sit/stay" and "down/stay" commands in distracting conditions?
Yes     No

Is your dog under reliable control off-lead?
Yes     No

Has your dog had formal obedience training?
Yes     No

Please list any special tricks your dog performs, if any:


Please send us the test reservation form in the mail along with our informational packet.

If you check this option, we will send you a test reservation form along with the test prep materials, and you can send the reservation form and $35 fee in when you and your dog feel ready to test!

If you and your dog would like to reserve your spot in our testing program as soon as possible you can print out the Test Reservation Form and mail it in with your reservation fee. You will receive confirmation that we received your reservation.