Facility Therapy Dog

Facility Therapy Dog Application

"*" indicates required fields

Applicants Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Cell Phone*

Home Phone

Office Phone

Name of School or Facility*

Address*

Street Address Address Line 2 City State ZIP Code

Describe the school, schools, or facility where the dog will be working*

How do you think the facility therapy dog will assist the learners in the school environment? What are your expectations? Please share your vision.*

Do you foresee the dog moving from room to room or do you foresee learners coming to the dog? Explain.*

Schools and facilities have a variety of learning settings/classrooms for students. Will the facility therapy dog be supporting a variety of different learners? Explain.*

Does your facility remain open during the summer?*

How did you hear about BluePath?

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892222577

Facility Therapy Dog