America’s VetDogs

 Facility/Therapy Dog Online Application

Facility Information

Facility Name:  

Department or Unit the dog will be assigned to:  

Address:  

City:  

State:  

Zip:  

Phone:  

Fax:  

Email:  

Primary Dog Handler Information

First Name:  

Last Name:  

Title/Position:  

Personal Address:  

City:  

State:  

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: 

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?