A Rinty For Kids Foundation, incorporated ~ ARFkids

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Visiting Pet Assisted Therapy Partner Program
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Application for a
ARFkids Visiting Pet Assisted Therapy Dog Candidate Puppy

* required
Name of Applicant:*
Date of Birth:
Age:*
Gender:
Street Address:*
City:*
State:*
Zip Code:*
Daytime Phone Number:*
Evening Phone Number:*
Email:*
Other Contact Number:*
Place of Employment:*
Street Address:
City:
State:
Zip Code:
Type of Work:*
Will you visit hospitals, hospice, schools and busineses with the ARFkids Dog?:*
  yes    no
If yes, what hospitals,hospices, schools and businesses?:*
Street Address:
City:*
State:
Zip Code:
Describe what you see as a typical day for the visiting activities:*
 
What are your goals for the future?:*
Do you live in a: House
Apartment
With a family member?
Other:
Do you have other animals: yes    no
If so, what kind?:
If you have a dog, what breed?:
Age?:
Dog's sex: female    male
Is the dog altered: yes    no
Do you allow your dog to run loose?: yes    no
Is your dog allowed indoors?: yes    no
Do you have a veterinarian who cares for your animals?:
  yes    no
Veterinarian's Name:
Street Address:
City:
State:
Zip Code:
Do you have a fenced yard?: yes    no
Have you ever particiapted in a Pet Assisted Therapy Program? Please explain.:*
 
What tasks will you expect the ArfKids Dog to perform?:
 
Will you be willing to work with any breed of dog that ArfKids determines will be most suitable for your situation?:
  yes    no
If no, explain:
Will you be willing to take responsibility for the care of the ArfKids Dog:
  yes    no
If no, who will care for the dog?:
    











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