Dear Prospective Volunteer,
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- Piers Norton
- 5 years ago
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1 Dear Prospective Volunteer, Thank you for your interest in the Pet Pals pet therapy program. This program screens teams of volunteer dogs and their owners for visiting patients at the American Family Children s Hospital (AFCH). Our goal is to provide these very special children with safe and enjoyable visits from loving canine friends. Participating volunteer teams successfully complete a four-step process and commit to at least two years of service in the program, visiting the Children s Hospital 1-3 times each month (Tuesday evenings or Saturday afternoons). We realize that completing the steps is time-consuming and that only about one in eight evaluated dogs will be invited to become Pet Pals volunteers. But the extensive Pet Pals evaluation process is critically important to ensure safe and enjoyable hospital visits for both the pediatric patients and our volunteer dogs. Step One Complete the Pet Pals application Fill out and sign the General Information & Behavior Questionnaire Have your dog s regular veterinarian complete the Veterinary Health form Carefully read the UW Hospital/AFCH/Pet Pals Safety & Infection Control requirements form then sign the form to indicate you understand and will adhere to the requirements. All three documents are included below. Send your completed application forms to: Pet Pals c/o Linda Sullivan, DVM, MA UW School of Veterinary Medicine 2015 Linden Drive Madison, WI Applications are reviewed by Pet Pals/UW-School of Veterinary Medicine veterinarians. Step Two Pet Pals Behavior Evaluation The annual Pet Pals Behavior Evaluation consists of a rigorous "hands-on" behavior assessment by program veterinarians and experienced Pet Pals volunteers. The evaluation is generally scheduled on a Sunday morning in August at the UW-School of Veterinary Medicine. Step Three Become a UW Hospital/AFCH Volunteer Once your dog passes the behavior evaluation, contact UW Hospital/AFCH Volunteer Services and become an official volunteer. The following website will provide all of the information you need to get started. Be sure to indicate that you and your dog will be a Pet Pals team at the American Family Children s Hospital. If you have any questions, please contact Volunteer Services at (608) After all AFCH volunteer requirements are complete, contact Diane Peltin at dop@tds.net to schedule your initial Pet Pals shadow visit.
2 Step Four Pet Pals Medical Evaluation The final stage includes a complete physical examination and laboratory screening for your dog at the UW-School of Veterinary Medicine (SVM), typically on a Sunday morning in December. The medical evaluation is conducted by SVM faculty and students at no cost to you. Upon completion of this final step, you and your dog will be welcomed into the Pet Pals family and scheduled to begin visits at the Children s Hospital. Thank you again for your interest in our program - we look forward to hearing from you!! Sincerely, Dr. Linda Sullivan UW School of Veterinary Medicine Pet Pals Coordinator
3 PET PALS GENERAL INFORMATION Your name(s): Address: Primary phone contact #: +/- Other phone # address: Dog s name: Diet: Breed: Color: circle: Spayed/Neutered (REQUIRED) Birthdate: PET PALS BEHAVIOR QUESTIONNAIRE Please take the time to think about the following questions and answer them as honestly as you can. There are no right or wrong answers! Please comment on how your dog relates to: Men: Women: Children: Other dogs: Please place an "x" next to behaviors or traits your dog exhibits or has exhibited: Likes to be petted Likes to be groomed Likes to follow you around Likes to play with you Responds to praise Avoids direct eye contact Shakes/"kills" toys Jumps on people Growls if surprised or startled "Guards" his/her toys Bites people Urinates if yelled at or scared "Guards" his/her territory Chases cats Growls if you disturb his/her eating "Guards" you or children Chases cars Hides behind you if scared Will sit on command Chases bikes Mounts other dogs/pillows Chews on furniture Attacks if cornered Defecates in the house Fights with other dogs Barks excessively Is frightened by thunder Dislikes slippery floors Dislikes handling Is frightened by brooms/vacuum Is your dog 100% housebroken? How does he/she indicate a need to go out? I hereby certify that the information I have provided is truthful and accurate. Signature: Date:
4 PET PALS VETERINARY HEALTH INFORMATION Owner name: Volunteer dog name: Veterinary Clinic: Veterinarian: Phone: Address: Current vaccinations Date administered Due date DA2(H)PP Rabies (tag ) Leptospira Kennel cough Parasite control Test date Results Heartworm antigen Fecal flotation (if done) Major medical problems, if any: Current medications, if any: Allergies to medications, if any: Veterinarian's Signature: Date:
5 SAFETY & INFECTION CONTROL REQUIREMENTS UW Hospital/AFCH/Pet Pals Veterinary certification regular veterinarian: Rabies virus every three years Distemper virus, adenovirus-2 and parvo virus vaccine every three years or adequate titers Kennel cough (Bordetella bronchiseptica, parainfluenza virus) vaccine - yearly Leptospira (serovars canicola, icterohemorrhagica, grippotyphosa, pomona) vaccine yearly, preferably in spring Biannual Pet Pals Medical Evaluation - UW-School of Veterinary Medicine: History Physical examination Diagnostics o Hematology screen (PCV, plasma protein) o Fecal flotation for gastrointestinal parasites (annual) Additional canine requirements: Dogs must be at least one year of age Dogs should be spayed or neutered Heartworm testing and preventive including gastrointestinal parasiticide Flea and tick preventive No raw diets Bath within 24 hours prior to visits Do not visit if dog on antibiotics Do not visit if dog exhibiting clinical signs of skin disease/compromise, diarrhea or cough Requirements for human volunteers: Annual influenza vaccination (required by UW Health Volunteer Services) Hand hygiene before and after visits Do not visit if volunteer exhibiting symptoms of communicable disease Completion of all UW Hospital/AFCH Volunteer Services requirements I hereby certify that I have reviewed, understand and agree to comply with the safety and infection control requirements listed above. Signature (s): Date: Date:
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10832 Knott Avenue Stanton, CA 90680 Phone: (714) 821-6622 Fax: (714) 821-6602 info@crossroadspetresort.com TRAINING & BEHAVIOR QUESTIONNAIRE Please return these forms prior to the day of consultation.
Thank you for choosing Ruffin It Resort! We look forward to making your dog s dreams come true!
Ruffin It Resort 635 Struck Street - Madison, WI 53719 Phone: (608) 310-4299 Fax: (608) 310-4298 Site: www.ruffinitresort.com Enrollment Application Please complete the following questions to the best
We also please ask that you inform us immediately if you re-home your dog privately. This saves the Society from arranging unnecessary home visits.
Dear Sir/Madam, Dog Registration Form Thank you for your letter/phone call regarding re-homing your dog. Would you please complete the enclosed form and return it to the office along with a covering letter,
Registration Form. Pet Parent Information
Registration Form Pet Parent Information Owner s Name Address City State Zip Home Phone # ( ) Work Phone # ( ) Cell Phone # ( ) Email Address Emergency Contact Information: (Others authorized to pick-up/make
Daycare & Boarding Application
New Daycare/Boarding Applicant Additional Family Member Existing Member s Updated Information Daycare & Boarding Application Guardian s/owner s Name: Address: City: State: Zip: Home Phone: ( ) Work Phone:
DOG DAYCARE APPLICATION FORM
DOG DAYCARE APPLICATION FORM How Did you Hear About Us? Your Name: Address: Postal Code Home Phone ( ) - Work ( ) Cell: ( ) Email Address: If we can t get in touch with you who can we call? (Emergency
Dog s Name: Dear Dog Owner,
Enrollment Application p. 1 Dear Dog Owner, Thank you for your recent inquiry about our dog enrichment center. At, we partner with owners who have a lifelong commitment to socialization, training, and