Class Certification Application
Cost of Class $250.00 1 handler/dog $350 2 handlers 1 Dog Cost includes: 1 Year liability insurance I.D badges for handler and dog PCTD logo Polo Shirt Dogs Vest There are three phases to being accepted into Pawsitive Changes Therapy Dog's Training Program. 1. Complete the Application and submit the required documentation 2. In-Person evaluation (you will be notified after application and docs are received. 3. Acceptance letter into the training program.
Email
First Name
Last Name
Phone Number
Address
Dogs Name
Dogs Breed
Dogs Age
Is your dog spayed/Neutered?
Please list any prior training classes you have taken, Where and When
500
Are you currently or have you been a active member of a Therapy Dog Group? Please answer yes or no .
If you answered Yes to the above question, which group are you a member of?
Have you ever been convicted of a felony? Please indicate Yes or No If yes please explain. Include State, court case number date of conviction
Do you have a valid State of Michigan drivers license?
Do you have proper insurance on your vehicle?
How Long have you had your dog?
Where did you purchase your dog from? Breeder? Rescue?
Is your dog super excitable around people? Please explain the reactions
Is your dog super excitable around other dogs? Please explain the reactions.
What areas do you socialize your dog? Example: dog friendly stores, County Parks
Has your dog been introduced to: Elevators? Bridges? Medical Equipment? If yes which and where?
Has your dog been exposed to automatic doors? Rotating doors? Loud alarms?
Do you attend Dog Day Care? Dog Parks? If yes how often and why
Please explain your interest in becoming a Therapy Dog team:
Please list your vet name and contact information
Date
Your Signature
*
Clear
Please submit the following documents with your application: Most recent vaccine record, Photo of your dog, Copy of County or City dog License, Copy of Drivers License
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