Personal Therapy Dog Application

Cette application est pour le programme d’adoption de chien de thérapie personnelle Companion Paws de TLC. Un chien de thérapie personnelle (chien de soutien émotionnel Companion Paws) est un chien dressé, testé, évalué et certifié qui apporte des avantages à ses propriétaires / maîtres qui luttent contre des problèmes de santé mentale.

Si la demande ne se soumet pas correctement à partir de votre ordinateur, vous pouvez remplir la demande de thérapie personnelle pour chien en utilisant le document Word qui se trouve au lien suivant, Application et envoyer par courriel la demande dûment remplie avec la documentation requise à Advisory@TheLifeLineCanada.ca

Name *

Age *

Email *

Phone *

Address *

Apt, suite, etc.

Country

City

State

Zip code

Mental Health Provider phone #: *

Mental Health Provider *

Upload a letter from your physician stating that a therapy animal would be an effective help. *

Names, ages, occupation and relationships of all members of household: *

Home size (square footage) *

What is the size if your property? *

Do you live in a rental unit? *

Yes

If renting, please upload a letter (pdf format) from your landlord stating that permission to keep a dog on the property is granted.

How long have you lived in your home? *

Do you have a fully fenced yard? *

Yes

Please describe size, height and type of fencing. *

If not fully fenced, how will you keep your dog safe while it is outside? *

How would you describe your household? *

Loud

Calm

Busy

Quiet

How much interaction has/have you and your child(ren) had with dogs in the past? *

Does anyone in the home have known allergies to dogs? *

Are you looking for a particular size, sex or age of dog? If so, why? *

Please describe your perfect companion pet (including behaviors i.e. energetic, playful, lap dog, lazy, etc.) *

What does adopting a rescue dog mean to you? *

Have you previously ever adopted a dog? *

Yes

Do you currently have any pets? *

Yes

Number, Type and Description of any other pets in the house *

Write N/A if not applicable

Are these pets spayed or neutered? *

Yes

Are these pets up to date on vaccines? *

Yes

Have you previously owned any pets in the last 10 years (other than any you may have now), and what became of those pets? *

Where do current pets/did previous pets spend most of their time? *

What are you currently feeding your dogs (type of food and brand)? *

Are you capable of caring for a companion animal? (Exercising, walking, feeding, playing, grooming, and training) *

What is the work schedule of the family members, and how long would a dog be in your home alone? *

How and how long do you plan to exercise a dog both on-leash and off-leash? *

Describe your current daily activities. *

Where will the dog spend the day? *

Where will the dog spend the night? *

Number of hours (average) dog will spend alone? *

What are your thoughts on crate training? *

If 'other', please specify.

If you were to move in the future, what would happen to your dog? *

Have you ever surrendered a pet? *

Yes

If yes, please tell us why.

Explain how you will be able to manage the training of the dog in accordance to your current work / leisure schedule *

Do you intend to take the dog for regular medical checkups and keep vaccinations up to date? *

Yes

Are you willing and able to pay for any future medical needs of your pet which can average $1,200/year? *

Yes

Name and contact information of your Veterinarian/Clinic you will be using *

Do you agree to provide regular health care by a licensed Veterinarian? *

Yes

Do you agree to keep the dog as an indoor pet? *

Yes

Have you talked to all of the people in your household about adding a dog to the household, and do they agree? *

When traveling/away from home, what arrangements will you make for the care of your dog? *

Are you prepared to make the 10-15 year commitment a dog requires? *

Yes

Are you willing to let a representative of Companion Paws or the Rescue have a home visit by appointment? *

Yes

Are you able to fund the $2800 cost of the adoption program? *

Yes

Upon submission of the completed adoption application, you will be contacted within 1 week, with the next steps of the process.

Any additional information you would like to add?

Reference #1 (Name, phone number and relationship) No more than one relative or family member *

Reference #2 (Name, phone number and relationship) No more than one relative or family member *

Reference #3 (Name, phone number and relationship) No more than one relative or family member