Children's Programs Team Application

Pet's Name: *

If “Yes” Please explain: *

Are you willing to publicize our visits: Internally at your facility? *

Yes

No

City: *

Phone *

Pet's Age: *

4. Remaining quiet and “settled” long enough for children to interact, (5-10 minutes at a time) ? *

Enjoy

Tolerate

Avoid

On your website? *

Yes

No

Name & Address of current veterinarian: *

2. Hugs? *

Enjoy

Tolerate

Avoid

CAP is an all-volunteer charitable organization. Visits are made possible through the generosity of members who give of their time, pay for their own training and pay annual membership dues. CAP must also rely on the charitable contributions from the facilities we visit or their “Friends Of” organizations. Are you able to make a contribution each year?

Yes

No

5. Has your dog ever bitten or nipped an adult or child? *

Yes

No

Zip Code: *

Where:

Date *

3. Being touched on face, ears, nose, toes, tail, or feet? *

Enjoy

Tolerate

Avoid

Why do you want to become a Children's Program Team? *

In your newsletter? *

Yes

No

4. Remaining quiet and “settled” long enough for children to interact? *

Enjoy

Tolerate

Avoid

7. Is there any situation that upset or frightens your dog? *

Yes

No

6. Does your dog bark at children? *

Yes

No

Where do you currently visit as a CAP Team? *

Pet's Sex: *

Male

Female

Address *

What is the name of the CAP captain at the facility(ies) you visit? *

Date of Most Recent Rabies Shot: *

How often does your dog interact with children? Describe the setting and interaction below. *

Pet's Breed: *

Email: *

Is your pet neutered/spayed: *

Yes

No

Have you completed at least 6 visits to a CAP Adult Care facility? *

Yes

No

In the local media? *

Yes

No

How does your dog react to the following.... 1. Close contact with children on the floor or a chair? *

Enjoy

Tolerate

Avoid

State: *

Do you have any questions or additional information?

Your Name: *

Address line 2

Donate Now!

Companion Animal Program:

Children's Programs Team Application

Donate Now!

​​​

Companion Animal Program:

Children's Programs Team Application