Therapy Dog Permission Form
Below, please fill out the e-permission slip indicating whether or not your child has your consent to be in a classroom visited by the Circleville Elementary School therapy dog in 2020 as a part of our new student wellness program. Forms due January 10th, 2020.
Student First Name: *
Your answer
Student Last Name: *
Your answer
Circleville Elementary will be hosting “therapy” dog’s visits. This volunteer program gives students the opportunity to interact with trained registered therapy dogs while at school. Handlers and their dogs will work with small groups of students during school hours for approximately 10-15 minutes. This signed Parental Permission Slip is required to participate in these events. *
Parent E-Signature: *
Your answer
Does your child have an emotional or physical sensitivity to dogs? If so, explain. If not, skip.
Your answer
Student Homeroom *
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