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Animal Assisted Therapy Program Application

Before applying to the Edward Animal Assisted Therapy program, your dog should consistently perform the following commands. These should be accomplished with one command..."dog sit" and the dog puts his rear on the ground.

  • Sit on command
  • Down on command
  • Stay and recall on command
  • Walk loosely on a leash without pulling, even when excited
  • Get along well with other dogs
  • Able to perform required commands without treats

    Other requirements:

  • Your dog should like people
  • Your dog should not be overly vocal
  • Your dog needs to be at least one year of age
  • Handlers must be 18 years or older
  • Dogs must be up to date on all vaccinations. Titers are not accepted in the program.
  • You must bring proof of current rabies vaccination to temperament testing.
  • Dogs must be free of all skin problems
  • Prong collars, gentle leaders and retractable leashes are not acceptable.
  • You and your dog are encouraged to have completed a group obedience training class within the past year.
  • Training Commitment
    Select qualified applicants will be invited to have their dog's temperament tested. You will be notified of the next scheduled temperament testing by email. If you and your dog are selected to participate in our program, you will need to provide proof of current vaccinations. Handlers and their dogs will then attend a 2-day intensive training and certification course. Following the successful completion of your training and registration as a therapy dog team, handlers will be required to maintain a therapy dog registration, for insurance purposes, at the organization of their choice. There is a minimal annual fee to maintain your membership with a therapy dog organization.

    By completing the following application, I understand the time and financial commitment involved with becoming an Edward certified dog/handler. I understand my services will be exclusive to Edward Hospital and Health Services. I also understand I am required to fulfill all of the veterinarian requirements outlined in the pet requirements. By submitting this application, I fully accept all the terms and conditions stated above.



    * Indicates required information
    General Information 
    Date:   Calendar (mm/dd/yyyy)
    First Name: * 
    Last Name: * 
    Email Address: * 
    Home Phone: * 
    Work Phone: * 
    Cell Phone: * 
    Street Address 1: * 
    Street Address 2: 
    City: * 
    State: * 
    Zip: * 
    Occupation: * 
    Employer: * 
    How did you hear about the program? * 
    Have you ever done dog therapy work with your dog named on this application? * 

    Where? 
    Are you currently Therapy Dog Certified? * 

    If yes, by which organization? 
    Date of Certification:   Calendar (mm/dd/yyyy)
    Dog Information 
    Dog Breed:  * 
    Age: * 
    Dog Birth Date: *   Calendar (mm/dd/yyyy)
    Dog's Name: * 
    Gender: * 

    Spayed/Neutered: * 

    Weight: * 
    Has your dog attended group obedience classes? * 

    Trainer used, how long ago, and what level was completed? 
    Is your dog currently on year around Flea Protection * 

    Flea protection brand? 
    Heart worm brand: * 
    Veterinarian: * 
    Phone: * 
    Does your dog live with you? * 

    How long? 
    Please write a paragraph about why you are interested in participating in this type of program. * 
    Volunteer Shifts 
    All volunteers are required to work minimally once every other week. We currently have the following shifts: (Please check any shifts you would be able to work. Your selection does not guarantee that schedule). * 








    How many days/week would you like to volunteer? * 
    How many days/month would you like to volunteer? * 
    Are you a year around resident at the address listed above? * 

       



     

    (630) 527-3000

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    Edward Hospital & Health Services
    801 S. Washington, Naperville, IL 60540 • (630) 527-3000

    Naperville • Plainfield • Bolingbrook • Oswego • Woodridge
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