America’s VetDogs

 Facility/Therapy Dog Online Application

Facility Information

Facility Name:  Required Field

Department or Unit the dog will be assigned to:  Required Field

Address:  Required Field

City:  Required Field

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 Required Field

Zip:  Required Field

Phone:  Required Field

Fax:  Required Field

Email:  Required Field

Primary Dog Handler Information

First Name:  Required Field

Last Name:  Required Field

Title/Position:  Required Field

Personal Address:  Required Field

City:  Required Field

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 Required Field

Zip:  Required Field

Work Phone:  Required Field

Personal Phone:  Required Field

Fax: 

Email:  Required Field

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

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

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

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?