Caring Canines Therapy Dog Club of Southern Vermont - Application for Membership
 Regular Member ($35.00)          � Household Membership ($50.00)          � Supporting Member ($20.00)

           Payment of dues will be collected upon successful completion of dog/handler evaluation.
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Email *
Owner Information
Name *
Street Address *
City *
State *
Zip Code *
Telephone *
Dog Information
Name *
Breed *
Sex *
Date of Birth *
Color *
Number of Dogs in Household *
Spayed/Neutered *
In order to help us better understand you and your dog, please complete as much of the information below as you are comfortable with. If not applicable, please indicate with ‘NA’
How did you become aware of Caring Canines? *
List other clubs to which you currently belong: *
On what club committees have you served and/or what club related activities have you been involved with? *
List any dog related areas of interest: *
If accepted as a member of the C.C.T.D.C. of S.VT.,  what would you most look forward to? *
What is your perception of a therapy team? *
What type of visits you are interested in doing? *
Can you commit to at least 5 visits a year? *
Why do you believe that your dog is suited to therapy work? *
List any activities in which your dog has participated *
Does your dog have a Canine Good Citizen certificate (CGC)? *
Describe the level of your dog’s obedience experience *
Is your dog shy or nervous around crowds of people (describe)? *
Does your dog get along well with children (describe)? *
How does your dog act with multiple dogs and people in the room? *
How does your dog handle stress (describe)? *
What do you do as a handler to address this? *
What types of collars and leashes do you use? *
Has your dog ever bitten a human being? *
Is your dog hand shy? *
Has your dog ever been involved in a dog fight?   *
Describe you dog (check all that apply) *
Are you interested in participating in workshops offered by Caring Canines? *
Do you belong to another Therapy Dog organization? If yes, which one? *
Do you swear that the information submitted here is true and correct to the best of your knowledge and understanding? *
A copy of your responses will be emailed to the address you provided.
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