Contact Information

Email

Driver's License Number

Dog Information

Name

Breed

Availability

Volunteer Visit Requests/Interests

Special Skills or Qualifications

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.

Previous Volunteer Experience

Summarize your previous volunteer experience.

Emergency Contact Information

Email

Agreement and Submittal

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a member with U.S.A. Therapy Dogs, Inc. any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. **It is U.S.A. Therapy Dogs, Inc. policy to screen our potential members for criminal sexual and violent felony charges. By submitting this application, you are agreeing to allow U.S.A. Therapy Dogs, Inc. to perform a background check. The reason for this is some of the facilities (e.g.: day cares, hospice centers, schools) will require a Federal background check.**

Our Policy

It is the policy of U.S.A. Therapy Dogs, Inc. to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in becoming a member with us. COST: $250 FOR 1 DOG AND 1 PERSON COST: $300 FOR 1 DOG AND 2 PEOPLE

Membership Application

Membership Application

USA Therapy Dogs, Inc.