Lakeview Therapy Dog Opt Out for Student Interaction

Dear Parent or Guardian,

Lakeview Middle School has a Therapy Dog named Addie. She is a 20 pound Cockapoo!

Please be aware that no student is ever obligated to interact with Addie. If you do not want your child to interact with Addie, please fill out the information below! I will be diligent with those concerns and comply accordingly.


Jill Hazell, School Social Worker

Sign in to Google to save your progress. Learn more
Email *
Student's Last Name, First name *
Parent/Guardian Name *
THERAPY DOG INTERACTION *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Parkhill.k12.mo.us.

Does this form look suspicious? Report

Google Forms