America’s VetDogs

 Facility/Therapy Dog Online Application

Facility Information

Facility Name:  

Department or Unit the dog will be assigned to:  

Address:  

City:  

State:  Alabama Alaska Alberta Arizona Arkansas Armed Forces Armed Forces America Armed Forces Pacific British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Lousiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon  

Zip:  

Phone:  

Fax:  

Email:  

Primary Dog Handler Information

First Name:  

Last Name:  

Title/Position:  

Personal Address:  

City:  

State:  Alabama Alaska Alberta Arizona Arkansas Armed Forces Armed Forces America Armed Forces Pacific British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Lousiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon  

Zip:  

Work Phone:  

Personal Phone:  

Fax: 

Email:  

Does the handler have any experience with dogs? Please describe:  

What is the handler’s current living arrangement?  Please include the names, ages & relationship of anyone else living in their home.  

Does the handler have any pets, inside or outside of their home?  

Secondary Dog Handler Information (optional)

First Name: 

Last Name: 

Title/Position: 

Personal Address: 

City: 

State:  Alabama Alaska Alberta Arizona Arkansas Armed Forces Armed Forces America Armed Forces Pacific British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Lousiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon

Zip: 

Work Phone: 

Personal Phone: 

Fax: 

Email: 

Does the handler have any experience with dogs? Please describe: 

What is the handler’s current living arrangement?  Please include the names, ages & relationship of anyone else living in their home. 

Does the handler have any pets, inside or outside of their home?