Wellbeing Dog (Ziggy)- Family Information

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dear Families,
We are excited to be beginning working with a wellbeing dog around your children this term.
Prior to commencement, we ask you to provide any information that may be relevant to your child
and our program. We are aware of the range of considerations that we need to make so that our
work is inclusive and successful. Below is a list of common considerations we like to be aware of.

Student Name: *

Student Year Level

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Clear selection

Please tick any boxes below to indicate considerations for program facilitators to be aware of. If extra information needs to be supplied, please use the space provided an the bottom of this survey. *

My child has a dog at home

My child has been around domestic animals frequently

My child has an allergy to some dogs

My child’s traditional culture does not allow interaction with dogs

My child’s religion does not allow interaction with dogs

My child has some degree of fear of dogs

My child has been through trauma related to an incident with an animal

My child has not yet experienced interaction with a dog

If you do not wish for your child to be directly involved or engaged with the Dogs Connect program, please indicate below:

I do not wish for my child to be directly involved or engaged with the Dogs Connect program

Clear selection

If there are any concerns or issues around your child's interaction with a dog or any extra information that the school needs to be aware of, please indicate below?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Catholic Education Office, Diocese of Wollongong.

Does this form look suspicious? Report

Forms