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OTD Member Application

Member Profile
Email:
Address: Area of city:
Phone (res): Phone (bus):
Age of Your Dog:

under 18 years over 18 years
Education/Professional Background:
Occupation:
Special Hobbies/Interest Areas:
Languages Spoken/Understood (other than English):
Previous Volunteer Experience:
Health Status (Do you have any health concerns that you want us to be aware of when considering a placement?) No Yes, if yes, please explain:
Why are you interested in becoming involved with a pet therapy program and what do you hope to contribute?
What do you expect to learn from this program? 
When are you available for making therapy visits? (Check all that apply.) Weekday mornings   Weekday afternoons   Weekday evenings Weekends  Not sure/varies
My companion animal and I are most interested in (i.e. kind of visit; check all that apply): animal-assisted activity program
"meet and greet" visits with several clients together
"therapy" work with professional one-to-one visits  demonstrations  READ literacy program (note: must have one year of OTD therapy dog work to apply for reading program)
My companion animal and I would be comfortable visiting in (check all that apply): active treatment
psychiatric/mental hospital
"special care" (e.g. Alzheimer unit) hospice/palliative residential continuing care  
day program
correctional facility
not sure
My companion animal and I would be comfortable visiting in (check all that apply): active treatment
psychiatric/mental hospital
"special care" (e.g. Alzheimer unit) hospice/palliative residential continuing care  
day program
correctional facility
not sure
people with cognitive impairment (such as Alzheimers)
people with psychiatric/emotional illness

References

Please supply the names and telephone numbers (both daytime and evening) of two local references (known to you for a minimum of two years but not family members):

First Reference: Name:
Phone Day :
Phone Evening:
Second Reference Name:
Phone Day :

Phone Evening:


Name:  
Yes No

Notes:

  • Bitches in estrus may not visit, and are advised against visits when pregnant.
  • Dogs must be a minimum of 2 years and younger than 11 years to test.
  • Rescued/re-homed dogs must be in new owner’s home for more than 1 year before being evaluated.

Female Spayed Yes No

Date of Birth:

At what age did he/she come to live with you?
Name of veterinarian: Clinic:
Has he/she had any formal obedience training with you? Yes No If yes, what level? Where?
Describe obedience/training/correction used:
What commands does he/she respond to?
Does he/she perform any tricks? Yes No If yes, describe:
Does he/she have any behaviours that are problems of concerns for you (e.g. mouthing, jumping up, excessive vocalization, submissive urination)? Yes No If yes, describe:
Please describe your animal’s socialization/behaviour around other animals:
Is there any group of people that your dog is not comfortable with (e.g. people with hats or sunglasses, people in uniform, men with beards, children, people with dark skin)? Yes No If yes, describe:
Has your dog ever lunged, growled, snapped or bitten a person? Yes No
Another animal? Yes No If yes, please describe circumstances:
How does your animal react to new situations?


Registration Process

Ottawa Therapy Dogs Inc.

Becoming a member of Ottawa Therapy Dogs Inc. begins with supplying the information requested in this application form, providing a $15.00 evaluation fee (non-refundable), submitting a copy of a current rabies certificate, and two valid pieces of identification with your name and date of birth, one of which must be photo ID for police checks (health cards are not accepted by police). We are available to answer any questions about the form, and about the process of becoming a working therapy dog team.

The identification that will be accepted by the Ottawa Police Service follows:

Photo Identification
(which provides photo, name and date of birth):		 Non-Photo Identification
(which provides both the name and date of birth):
  • Driver's Licence (Recent utility bill required to verify current Ottawa address if no Driver's Licence is available.)
  • Government Employment Card
  • Military Employment Card
  • Age of Majority Card
  • Canadian Citizenship Card
  • Indian Status Card
  • International Student Card
  • Passport
  • Permanent Resident Card
  • Firearms Acquisition Certificate (FAC)
  • Canadian National Institute for the Blind Card (CNIB)
  • Birth Certificate
  • Baptismal Certificate
  • Hunting Licence
  • Fishing Licence
  • Outdoors Card
  • Hospital Card
  • Canadian Blood Donor Card
  • Immigration Papers

Ottawa Therapy Dogs Inc. (OTD) requires that dog and handler (the team) pass an evaluation by an OTD Evaluator. The fee for each dog evaluated is $15.00, to be submitted with this application form along with a copy of a current rabies certificate (Note: dog cannot be tested without submission of rabies certificate or copy). After a successful evaluation, all required documentation — that is, an OTD Registration form signed by the Evaluator and applicant, OTD vet form signed by your vet, and $35.00 registration fee must be submitted to OTD for approval. The registration must be received within three months of the evaluation. The OTD membership fee of $35 is renewable January 1 of each year. Upon receipt of OTD membership, the team may begin working with Ottawa Therapy Dogs Inc.

Applicants must attend an orientation session prior to evaluation.  Additionally, some facilities require that therapy dog handlers attend an institutional volunteer training session.

After receiving OTD membership, we will assist the new team in selecting a placement for therapy work, with the aim of finding a "good fit" and a rewarding experience for dog, handler and client(s). For the initial two visits, the handler accompanies an experienced therapy team, without bringing his/her own companion animal. Then the new team is accompanied by an experienced handler for two visits. This mentoring arrangement helps to support the new team in gaining skill and confidence in their work.

After the placement is underway, we are available to answer questions, help solve problems that may come up, or arrange for a change of placement or an expansion of duties, as needed. Handlers are required to inform OTD if they will be absent for periods longer than 2 months or if they wish to make changes in their placement.

Ottawa Therapy Dogs Inc. meets during the year for orientation, evaluation, fundraisers or meetings. Members are invited to volunteer their time to OTD in any area of our work which may be of interest, attend meetings and help out at events.

We look forward to welcoming you and your dog to Ottawa Therapy Dogs Inc., and contributing to our community with this wonderful form of volunteering.

Yes

  • I verify that all information submitted is truthful and complete.
  • I have read and agree to abide by the terms of the registration process as described above.
  • I have submitted the non-refundable $15 evaluation fee payable to Ottawa Therapy Dogs Inc.
  • I have submitted a current rabies certificate for my dog and two valid pieces of identification. (Items can be sent by fax to 613.261.6834 or scanned, sent by email to info@ottawatherapydogs.ca, or sen by mail at the address below.)
No, please explain.

Thank you from...

Ottawa Therapy Dogs
Suite 750
1500 Bank Street
Ottawa, ON K1H 1B8

Should you have any questions, call 613.261.6834 (OTDI) or email us at info@ottawatherapydogs.ca

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Last Updated: February 7, 2010
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