Love On 4 Paws Animal Assisted Therapy

Volunteer Questionnaire
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 Please complete and submit the following questionaire. A Love On 4 Paw representative will contact you within 4 business days.

Items marked with bold are required.
Owner's Name:
Address:
Suite/Apartment:
City:
State:
Zip:
Telephone:
Email:
Dog 1
Dog's Name:
Dog's Breed:
Gender:
 Female Male
Dog's Age:
Spayed or Neutered:
 Yes No
How much obedience training has your dog had?
Does your dog respond to the following commands?
Sit:
 Yes No
Down:
 Yes No
Stay:
 Yes No
Leave It:
 Yes No
Does your dog reliably loose leash walk?
Yes No
Dog 2
Female Male
Yes No
A
A
Yes No
Yes No
Yes No
Yes No
A
Yes No
Are you currently volunteering for any
other animal assisted therapy program?		 Yes No
If yes, please explain why are you being screened by
Love On 4 Paws:
How / where did
you hear about
Love On 4 Paws?
Comments / Questions?
Items marked with bold are required.

Love On 4 Paws – Animal Assisted Therapy
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