Appendix 2 from the book

The following are more appendix items we wanted to include our book, Service Dogs: The Rescue and Training of Heroes but didn't have room. We don't always use these exact tests or procedures, but they can be helpful as reference tools. Here is the first appendix (of 2).

Alaska Airlines Policy on Service Dogs in Training

Alternate Candidate Test (if the dog is not fostered, but you can meet the dog in person)

Application for a Service Dog for a Child (Under 18 years)

Application for Service Dog

Bringing a Service Dog to Hawaii

Career Change Dog - Agreement

Career Change Dog - Application

Checklist for Dog’s Basic Needs

Checklist for First Aid Kits

Checklist for Handler Standards

Checklist for Health Records

Checklist for Keeping Current Information

Checklist for Kennel (If a Kennel is Being Used)

Checklist for Medications

Checklist for New Dog

Client Manual

Contract for Clients

Contract with Veterinarian

Criteria for Matching Dogs to Handlers

Dog Feeding Chart (Weekly)

Fundraiser Sign-in Sheet

Medical Form for Clients

Policy for Candidate Dogs on Health, Temperament, Task Aptitude, and Socialization

Pre-Application

Programs and Services

Release of Liability

Training Program Policies

Training Schedules, Plans, and Progress Reports

 

 

Alaska Airlines Policy on Service Dogs in Training

From: https://www.alaskaair.com/content/travel-info/accessible-services/specialservices-support-animals.as...

At Alaska Airlines, we will accept service animals-in-training free of charge that are being delivered to their new owner/handler’s home provided all of the following conditions are met:

1 - The service animal is being transported by a trainer.

2 - The trainer can identify the new owner's/handler's name and home city.

3 - The trainer can provide documentation on official letterhead noting the service animal has successfully completed training.

4 - Space must be available and confirmed in advance for traveling in the cabin or cargo compartment. (Limited and subject to availability).

In addition to being delivered to their new owner/handler, a service dog/puppy-in-training only may be accepted for travel free of charge while they are in training provided all of the following conditions are met:

1 - Travel is wholly within the United States.

2 - The service dog/puppy is being transported by their trainer/raiser.

3 - The trainer/raiser can provide a health certificate for the service dog/puppy in training on official letterhead from the assistance organization.

4 - The trainer/raiser can provide an official Trainer Identification card issued by the assistance organization.

5 - Space must be available and confirmed in advance for traveling in the cabin or cargo compartment. (Limited and subject to availability).

 

 

 

Alternate Candidate Test (if the dog is not fostered, but you can meet the dog in person)

We prefer the official Candidate Test because in a peer-reviewed study has validated it . If the dog has not been fostered, though, you can still test the dog in person in about an hour. Use the following 18 "subtests". The results of this in-person test are harder to examine, unfortunately. With experienced evaluator, though, they do correlate well with Test 2. The following is reprinted with the kind permission of Dr. Amanda Jones.

Directions: When each dog arrives at the kennel, he or she will be placed in a familiar, indoor kennel in a room familiar to the dog. The dog will remain there until his or her test period begins. Then, the dog will be released from the kennel into the room.

Subtest 1: Collar grab

A researcher will reach for the dog’s neck/collar and put a second collar on the dog; this collar will be attached to a leash for use in Subtest 2 - The dogs’ behavior will be rated on 5-point scales assessing how fearful, confident, aggressive, and friendly the dog appeared. Notes of other significant behaviors (e.g., not seeming to react to notice the researcher) will be made. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident?__ Friendly?__

Subtest 2: Walk on leash with stranger

The same researcher will walk the dog approximately 25 feet down a hallway familiar to the dog to a 10*15-foot room that is familiar to the dog. The dog’s on-leash behavior during will be assessed and rated on 5-point scales assessing how fearful, confident, excitable, calm, engaged/alert to the environment, easy-to-control, submissive, and pushy/assertive the dog appeared. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Excitable?__ Calm?__ Engaged and Alert?__ Easy to Control?__ Submissive?__ Pushy, Assertive?__

Subtest 3: Threatening approach

The researcher will stand still but ignore the dog. A second researcher (unfamiliar to the dog) will approach the dog. The researcher will exhibit mildly threatening behavior, targeted towards the dog, including staring directly at the dog and looming (leaning slightly) over the dog. The dog’s behavior will be carefully observed for signs of arousal, fear, and aggression, including raised hackles, panting, pulling back of lips and ears, backing away, and barking (among others). The test will be ceased if the dog exhibits aggressive behavior readily. The researcher will not come within range (such that the dog could touch or bite the researcher) unless the dog exhibits signs of friendly behavior (e.g., lip licking, tail wagging, whining, body wiggling/wagging). The dogs’ behavior will be rated on 5-point scales assessing how fearful, confident, aggressive, friendly, excitable, calm, playful, engaged/alert to the environment, and interested in people the dog appears. Notes of other significant behaviors (e.g., being distracted by a bird) will be made. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident?__ Aggressive?__ Friendly?__ Excitable?__ Calm?__ Playful?__ Engaged and Alert?__ Interested in People?__

Subtest 4: Friendly approach

If Subtest 3 indicates that the dog is friendly to the approach of an unfamiliar person who is mildly threatening, a second approach test will be conducted. The same stranger will leave, then re-approach the dog, talking in a friendly voice (“Hi! It’s so nice to see you! Who’s a good doggie?”). If the dog shows mild to moderate discomfort (e.g., fear, stress, aggression) during the approach in subtest 3 or 4, the test will be conducted using an artificial hand and so that the researcher will be kept at a distance from the dog. If the dog shows more than moderate discomfort (e.g., by attempting to bite), the test will be ended. The dog’s behavior during the friendly approach will be rated using a 5-point scale to indicate the degree to which the dog appears how fearful, confident, aggressive, friendly, excitable, calm, playful, engaged/alert to the environment, and interested in people. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident?__ Aggressive?__ Friendly?__ Excitable?__ Calm?__ Playful?__ Engaged, alert?__ Interested in People? __

Subtest 5: Affection/Petting from stranger

The researcher will kneel next to the dog, then reach towards the dog’s body to pet the dog in a minimally threatening fashion. The dogs’ behavior will be rated on 5-point scales assessing how fearful, confident, aggressive, friendly, excitable, calm, aloof/uninterested, playful, engaged/alert to the environment, interested in people, and affectionate the dog appears. Notes of other significant behaviors (e.g., ignoring the petting) will be made. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident?__ Aggressive?__ Friendly?__ Excitable?__ Calm?__ Aloof/Uninterested?__ Playful?__ Engaged and Alert?__ Interested in People?__ Affectionate?__

Subtest 6: Restraint

The researcher will hold the dog down on its side or back, as if the dog were undergoing an inspection at the veterinarian’s office. Pressure will begin as light but elevate to moderate over a 45 second period regardless of whether or not the dog struggles. The dogs’ behavior will be rated on 5-point scales assessing how fearful, confident, aggressive, friendly, calm, and excitable the dog appears; notes of other significant behaviors (e.g., whining) will be made. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident? __ Aggressive? __ Friendly? __ Affectionate? __ Calm? __ Excitable? __

Subtest 7: Other dog (on leash)

The target dog will be exposed to another dog, the test dog (a non-aggressive, male, neutered dog who is highly socialized). Each dog will be held on leash by a different person. The dog being assessed will be held by the same researcher who served as the stranger in subtest 3 and conducted all tests following subtest 3 - The test dog will be walked by the researcher who conducted subtests 1 and 2 - The test dog will be walked slowly around the room, and the target dog’s behavior will be observed. The dog will be rated (using a 5-point scale) on the degree to which he or she appears fearful, confident, aggressive, friendly, excitable, calm, aloof/uninterested, playful, submissive, and pushy/assertive. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident? __ Aggressive? __ Friendly? __ Excitable? __ Calm? __ Aloof/Uninterested? __ Playful? __ Submissive? __ Pushy/assertive? __

Subtest 8: Novel situation test (room)

The researcher will walk the dog out of the familiar room in which subtests 3-7 were conducted and into a room that is novel to the dog. The researcher will then drop the dog’s leash and let the dog explore the room. The researcher will not respond if the dog solicits attention. The dog’s behavior will be observed and rated on 5-point scales assessing how fearful, confident, excitable, calm, and engaged/alert to the environment the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident? __ Excitable? __ Calm? __ Engaged/alert? __

Subtest 9: Novel object (Remote controlled car, Jack-in-the-box)

The researcher will allow the dog to continue dragging his or her leash. The researcher will retrieve a remote-controlled car and set it on the floor. After 20 seconds, regardless of the dog’s response, the researcher will begin to drive the car around the room. After 1 minute of exposure to the car, the car will be removed and a Jack-in-the-box will be placed on the floor. The dog will be allowed to inspect closed, and which will then suddenly open. The dog’s behavior will be observed and rated on 5-point scales assessing the degree to which the dog appears fearful, confident, excitable, calm, and engaged/alert to the environment. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident? __ Excitable? __ Calm? __ Engaged/alert? __

Subtest 10: Doll test (Doll as child)

The dog will be held relatively stationary by the researcher while a second researcher approaches, holding a large (toddler-sized) doll by the hand, as if the doll were walking. The dog’s behavior during the walk and when he/she reaches the dog will be observed and rated on 5-point scales assessing how fearful, confident, aggressive, friendly, excitable, and calm the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident? __ Aggressive? __ Friendly? __ Excitable? __ Calm? __

Subtest 11: Prey drive

The dog will be exposed to a furry ball pulled on a string, then tossed. The dog’s behavior will be observed and rated on 5-point scales assessing how aggressive, excitable, calm, playful, and engaged in the environment the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Aggressive?__ Excitable? __ Calm? __ Playful? __ Engaged? __

Subtest 12: Engagement in play with tester

The researcher will excitedly ask the dog to play with a new squeaky toy. The researcher can nudge the dog with the toy, talk to the dog, clap his hands, kneel down, and run around to get the dog’s interest. The dog’s behavior will be rated on 5-point scales assessing how affectionate, excitable, calm, aloof or uninterested, playful, engaged/alert to the environment, and interested in people the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Affectionate?__ Excitable?__ Calm?__ Aloof/Uninterested?__ Playful?__ Engaged/alert?__ Interested in people?__

Subtest 13: Tug-o-war or toy release

The researcher will attempt to engage the dog in a game of tug-of-war with a rope toy. At the end of the tug-o-war game (up to 20 seconds of pulling), the researcher will tell the dog to release the toy and/or try to retrieve the object from the dog. Researchers will observe the dog for unwillingness to release the toy. The dog’s behavior will be rated on 5-point scales assessing how easy to train, easy to control, submissive, and pushy/assertive the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Easy to train?__ Easy to control? __ Submissive? __ Pushy/assertive? __

Subtest 14: Train new task

The researcher will attempt to teach the dog to hit a square block (paired with other shapes of blocks) in order to receive a reward. The reward will be a food reward, toy, or praise, depending on what appears to motivate the dog and on what the owner reports the dog enjoys. The researcher will point to the block, lure the dog to touch the block, then give the dog a reward. The researcher will spend up to 4 minutes using luring, shaping, and positive reinforcement (plus verbal corrections) to teach the dog. The dog’s behavior will be observed and rated on 5-point scales assessing how engaged in the environment and task, interested in people, easy to train, and obedient the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Engaged?__ Interested in people?__ Easy to train?__ Obedient?__

Subtest 15: Basic commands

The researcher will give the dog basic commands (e.g., “sit,” “come,” “down”) to get the dog to come, sit at a door, and then be released to go outside. The researcher will to give the dog that command without a food reward or other reward present, then with a reward if the dog does not perform without the reward. The dogs’ behavior will be rated on 5-point scales assessing how obedient the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Obedient?__

Subtest 16: Other dog (off leash)

The target dog will be released into a play yard, which is typically used at the kennel where the test is conducted and which is familiar to the dog. In the play yard will be another dog, the test dog used in subtest (a non-aggressive, male, neutered dog who is highly socialized). Both dogs will simply be loose in the play yard, as during any other play period, for 4 minutes. Their interactions and the target dog’s behavior will be observed. The target dog will be rated, using a series of 5-point scales, on of fearful, confident, aggressive, friendly, excitable, calm, aloof/uninterested, playful, submissive, and pushy/assertive the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Fearful?__ Confident?__ Aggressive?__ Friendly?__ Excitable?__ Calm?__ Aloof/Uninterested?__ Playful?__ Submissive?__ Pushy/Assertive?__

Subtest 17: Activity in free-play

The test dog will be removed from the play yard, and the target dog’s activity level when alone will be observed. The dog will be rated on a 5-point scale on how active, excitable, calm, aloof, playful, and engaged/alert to the environment the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Active?__ Excitable?__ Calm?__ Aloof/Uninterested?__ Playful?__ Engaged/alert?__

Subtest 18: Reunion with owner

The researcher will walk the dog back to the owner. The dog’s behavior during the walk and when he/she reaches the owner will be observed and rated on 5-point scales assessing how excitable, calm, aloof, interested in people, easy to control, submissive, and pushy/assertive the dog appears. Please rate the dog’s behavior from 1 to 5, with 1 being "Not at all" and 5 being "Extremely":

Excitable?__ Calm?__ Aloof/Uninterested?__ Interested in people?__ Easy to control?__ Submissive?__ Pushy/assertive?__

Scoring (the numerical standards are ours):

Fearful: __ (22 or more is a Fail)

Confident: __ (29 or below is a Fail)

Friendly: __ (24 or below is a Fail)

Excitable: __ (27 or more is a Fail)

Calm: __ (55 or below is a Fail)

Engaged/Alert: __ (20 or below is a Fail)

Easy to Control: __ (11 or below is a Fail)

Submissive: __ (6 or below...OR 24 or above is a Fail)

Pushy/Assertive: __ (16 or above is a Fail)

Aggressive: __ (6 or above is a Fail)

Playful: __ (25 or above is a Fail)

Interested in People: __ (23 or below is a Fail)

Aloof/Uninterested: __ (20 or above is a Fail)

Affectionate: __ (9 or below is a Fail)

Easy to Train: __ (6 or below is a Fail)

Obedient: __ (2 or below is a Fail)

 

 

Application for a Service Dog for a Child (Under 18 years)

Child’s Name:

Age:

DOB:

Parents’ Names:

Address:

City, state, zip code:

Email:

Phone Number:

Cell Phone:

Emergency Contact, and their phone number:

What is your child’s primary diagnosis?

Does the child have any other medical problems? (Please explain)

What limitations the child experience in everyday life?

Do you live an apartment, condo, or house?

Who else lives at your home? (Please list names, ages, and relationships)

Do you have a fenced-in yard?

What other animals live in your home?

Training a Service Dog takes six to twelve months. We ask families to help contribute to funding the training. We do not offer scholarships.

Does the child attend school?

Would you like the dog to go to school with the child?

Please confirm that you agree with our understanding about service dogs in school:

_____I understand that because the applicant is a child, the child cannot be “in charge” of the dog. The adult parent or adult teacher is in charge.

Service Dog Information

Is the child able to handle a dog on their own?

Who would help the child with a dog?

How would a service dog benefit your child?

How will the dog benefit you as a parent?

On a scale of 1-10 (with 10 being the highest), how much does your child like dogs? Please explain.

Is there anything else you would like to add?

Thank you so much - we look forward to talking with you!

 

 

Application for Service Dog

Name:

Age:

Names, relationships, and ages of family members in your home:

How much of the year do you live at your primary address?

Do you travel a lot? If so, please describe.

What type of home do you have (apartment, condo, house, etc.)?

Who else lives at your home?

Do you have a fenced-in yard?

On a scale of 1-10 (with 10 being the highest), how much do you like dogs? Please explain.

Have you participated in any dog training before? Please describe.

Please rate yourself in the following areas (1 being the lowest, 10 the highest)

Ability to think during a crisis

Ability to accept correction

Ability to laugh at oneself

Shyness

Responsibility

Ability to control feelings

Ability to handle stress

Perseverance to master new tasks

Enjoys social interactions with strangers

Like to take risks

Express emotions with ease

Has a temper

How could a Service Dog help your life?

Please describe how you will handle the following for your dog:

Do any animals visit you? If so, please describe:

Does everyone in your household support the idea of you having a service dog?

Are there any activities to which you wouldn't bring your service dog?

Are you able to travel to the organization for your interview? Can you then travel two more times for training (taking the dog with you on the plane home after the last visit)?

The program is difficult. What specific difficulties do you expect you might have?

What are you able to do to manage your difficulties while taking this training?

Do you have the financial resources to pay for the following without any help?

- Fundraising for the dog?

- Travel, food, and lodging during the training?

- Continued care of the dog throughout its life?

Would you plan to fundraise from friends and family, or just make the donations yourself?

All donations are tax-deductible. If you wish to donate stock, then you don't have to pay capital gains taxes. Are you planning to donate stock?

Acknowledgment of Terms and Conditions of Service Dog Placement

Should I be accepted into the Service Dog program, I will show aptitude, competency. I will have a commitment to follow the nonprofit's education, standards, and training. I understand that contributions are not payment for a Service Dog. Contributions may be given to the nonprofit on behalf of a particular person. I understand those funds do not constitute a sale. I will complete the fundraising and education, and I will prepare to receive the service dog. Only then will the Service Dog placement proceed.

Applicant Signature:

Date:

 

 

Bringing a Service Dog to Hawaii

From http://hdoa.hawaii.gov/ai/aqs/animal-quarantine-information-page/guide-service-dogs-entering-hawaii/

Updated July 1, 2013

The dog must have current rabies vaccination. (Documentation of the vaccination must include the product name, the lot or serial number, and the expiration date of the lot.)

The dog must have an electronic microchip implanted for identification.

Prior to arrival, the dog must have passed one OIE-FAVN test after 12 months of age, with a level of 0.5 I.U. rabies antibody or greater. The laboratory will not perform the tests unless the microchip number accompanies the test request form. A passing test result is valid for three (3) years.

The dog must have a standard health certificate issued not more than 30 days prior to arrival in Hawaii, attesting that the dog was treated within 14 days of arrival with a product containing Fipronil or an equivalent long-acting product labeled to kill ticks. A valid health certificate is required for each entry into Hawaii.

The task(s) the animal has been trained to perform should be disclosed.

The service dog must be traveling with the disabled user on arrival in Hawaii.

To prevent delays on arrival, it is strongly advised that all required documents be sent to the Rabies Quarantine Branch well ahead of your intended arrival date. Information can be mailed to the Animal Quarantine Station, 99-951 Halawa Valley Street, Aiea, HI 96701 or faxed to (808) 483-7161 - Staff may be contacted by telephone (808) 483-7151 or (808) 837-8092 or e-mail: rabiesfree@hawaii.gov to assist you with preparations.

The Rabies Quarantine Branch must receive notification at least 24 hours in advance of arrival information and location where the dog will be staying. Information can be faxed to 808-483-7161.

On arrival in Hawaii, the dog must be brought by the airline to the Airport Animal Quarantine Holding Facility for verification of compliance with the above requirements and examination of the dog for external parasites. If all is in order, the dog will be released at that point.

Qualified Guide dog and Service dog users may request inspection in the terminal at Honolulu International Airport between the hours of 8:00 am and 4:00 pm, by notifying the Rabies Quarantine Branch 7 days, or more before arriving. To avoid confusion and delays, the airline must be notified by HDOA so that airline representatives are aware that the inspection upon arrival in Hawaii will be at the terminal rather than the Airport Animal Quarantine Holding Facility. After inspection, if all is in order, the dog will be released.

If you have questions, please contact:

Hawaii Department of Agriculture

Animal Quarantine Station

99-951 Halawa Valley Street

Aiea, Hawaii 96701-5602

Telephone (808) 483-7151 (Due to the heavy volume of calls, e-mail questions to the office for faster response)

FAX (808) 483-7161

E-mail: rabiesfree@hawaii.gov

 

 

Career Change Dog - Agreement

The organization and new owner agree that the owner will abide by the following:

Adopter agrees:

I will keep the dog safe, well fed, and the dog will always have fresh water.

The dog will be an inside dog.

I will exercise the dog daily.

I will keep the dog leashed outside, but will not leave it chained up outdoors.

I will not train the dog to attack, nor to be used as a therapy dog or service dog.

I will take the dog to the veterinarian each year.

I will get the dog a city license.

If I don't want the dog at any time, I will give it back to the organization.

I release the organization from any liability, damages, or expenses, arising out of my owning the dog, and for any reason, including health, condition, training, behavior or temperament.

I will notify the organization if the dog is lost or dies, and if we move.

I understand if I fail to follow any of the above, I will give up the dog to the organization.

I understand that by signing this agreement, I am entering into a legal and binding contract. Breach of any term(s) of this agreement is deemed actionable by the organization. If a lawsuit is brought for any reason by either party, the lawsuit will be undertaken in a court in the state in which the organization is located. The loser of the suit will pay the lawyer’s fees of both parties.

Signature and date of new owner:

Signature and date of staff of organization:

 

 

Career Change Dog - Application

Thank you for applying for a "Career Change" dog. Please understand that the dog you are applying for is not perfect. This dog wasn't able to pass the stringent tests needed to be a service dog.

Your name:

Address:

City, State, Zip:

Email:

Phone:

Have you discussed getting a pet dog with everyone in your family? Are they all in agreement about getting a dog?

Names and ages of family members:

Do you live in a house or apartment?

Do you have a fenced in yard?

Do you have any other pets? If so, please describe:

Do any of the animals in your home have a bite history? If so, please describe:

How many hours a day will the dog be left alone (if any)?

Please describe any dog ownership experience and dog-training experience each family member has:

Do you have the funds to pay for dog food, regular veterinary care, and other expenses that may come up?

Are you willing to walk or play with the dog twice daily?

Are you willing to take a dog of any size or breed?

Are you willing to take a dog that is sick or injured?

Are you willing to keep the dog indoors and not leave the dog outside for long periods of time?

Do any animals visit your home? If so, please describe.

Do you travel regularly? If so, please describe how often you travel, how long you usually are gone from your home. Please describe where you would keep the dog while you're traveling.

By returning this application, you agree that if you are selected to receive a Career Change dog, you will not use the dog as an attack dog. You also agree not use the dog as a therapy dog or service dog. You agree that you will not give away or sell the dog without the express permission of the nonprofit. Finally, you agree to notify the organization if the dog dies or if you lose the dog.

 

 

Checklist for Dog’s Basic Needs

__Plenty of time with people

__Toys

__Food

__Always has access to fresh water

__Living in a dry place with a comfortable temperature

__Sufficient opportunities to toilet

__ Exercise

__Sufficient time to relax and play every day

__Grooming

__Veterinary care

 

 

Checklist for First Aid Kits

__Dog Thermometer

__Antiseptic

__Bandages

__Emergency contact

__Muzzle

__Rubber gloves

 

 

Checklist for Handler Standards

Make sure that the handler understands the following:

__Dog health

__Tasks

__Obedience

__Public Access standards

Signature of Trainer:

Date:

 

 

Checklist for Health Records

Dog’s name:

__Veterinary records

__Checked daily for ear infections, clean ears weekly

__No signs of illness or discomfort.

__Daily dinner

__Grain-free kibble

__Water available at all times

__If dog misbehaves, the behavior is ignored or the dog is cued to do an incompatible behavior

__Dog bed in the dog’s crate, and another dog bed in the living room

__Toys, bones, and chews

__Dry place to live, at a comfortable temperature

__The dog is given the opportunity to potty four times per day

__Two thirty-minute training walks each day

 

 

Checklist for Keeping Current Information

Dog's original name:

Dog's new name:

Date adopted by the organization:

How dog was obtained:

Paperwork of initial testing:

Date of birth:

Breed:

Health records:

Microchip number:

Registry number:

If career change dog, list date of career change:

If career change dog, list contact info of adopter:

 

 

Checklist for Kennel (If a Kennel is Being Used)

Is the kennel the right size?

Is the kennel easy to clean?

Is the kennel dry and at a comfortable temperature?

Is there fresh air and daylight?

Is there plentiful artificial light?

Are there toys, bones, and chew toys?

Is there always access to water?

 

 

Checklist for Medications

Dog’s name:

Medication:

Has the expiration date been checked?

January - signature and date:

February - signature and date:

March - signature and date:

April - signature and date:

May - signature and date:

June - signature and date:

July - signature and date:

August - signature and date:

September - signature and date:

October - signature and date:

November - signature and date:

December - signature and date:

 

 

Checklist for New Dog

To Do:

__ Prep folder

__ Set up initial vet visit

__ Spayed or neutered

__ Up-to-date on vaccinations

__ Healthy/free of worms, sores, illness, etc.

__ Get a bath

__ Housebroken

__ Go up and down stairs

__ Learn to go through the dog doors

Equipment:

__ Leather collar

__ Tag with our address

__ Microchip & tag

__ Rabies tag

__ Service dog tag (red cross)

__ Waist leash

__ Food pouch

__ Poop bag dispenser

__ Nose collar

__ Service dog vest

__ Nonprofit patch

__ Other patches as needed

__ Heartworm meds, NexGard, and other meds as needed

__ Food dish

__ Crate

 

Contract for Clients

[Name of Nonprofit] is a registered 501(c)(3) non-profit charity. The nonprofit is organized under the laws of the State of [Name of State], (“Nonprofit”). The Nonprofit and [Name of Fundraiser], (“Fundraiser”), agree as follows,

Nonprofit transfers all rights, privileges, liabilities, and responsibilities associated with the ownership of a Service Dog. The Fundraiser will receive the dog of the date and time specified below. The nonprofit will have spent at least six months training the dog for Fundraiser. The task is anxiety reduction and diversion. The Service Dog will be judged as being in good health by a veterinarian at the time training begins. The Service Dog will come with vaccination and veterinarian records. The dog also comes with vest, leash, and documentation of training. The Service Dog can be taken into public places such as restaurants, churches, and malls. The owner can have access to rental housing and can travel as a Service Dog and not a pet.

[Identify Service Dog and date of transfer]

Fundraiser agrees that in consideration of training this Service Dog, Fundraiser will adhere to the following code of conduct. The Fundraiser will ensure that the Service Dog will:

1 - Continue to receive training from Fundraiser even after graduation. At the discretion of Nonprofit, the dog and Fundraiser will be retested each year. The testing will serve as for re-accreditation as a service dog/handler team,

2 - Be given adequate and proper shelter and housed and exercised in a fenced, secure yard,

3 - Be kept in a clean condition and attached to a lead at all times whilst out of the Fundraiser’s yard or home. “Off lead” areas in parks are not recommended for any Service Dogs. The valuable trained dog could be injured if attacked by other dogs.

4 - Not be neglected, allowed to roam free, or be mistreated in any manner,

5 - Receive proper veterinary care, inoculations, and preventative care throughout its life,

6 - Receive adequate nutrition to maintain proper weight.

Furthermore, the Fundraiser will not lend, give or sell the Service Dog to any other person. The Fundraiser, and will not allow the Service Dog to be used as a service dog by anyone other than Fundraiser. The Fundraiser agrees not use or handle the Service Dog in any manner that would put anyone at risk. The Fundraiser will not use the Service Dog in any manner which would reflect poorly on the Fundraiser, the Service Dog, or Nonprofit.

Any material breaches of the above code of conduct will result in immediate removal of accreditation. If accreditation is revoked at any time, Fundraiser will be informed in writing. The Fundraiser must then return the Service Dog’s vest and all identification, immediately. The Fundraiser will notify Nonprofit of any serious injury, serious illness of the dog. The Fundraiser will notify Nonprofit long-term loss, straying, or death of the dog. The Fundraiser will notify Nonprofit of anything that hurts any person, animal, or property. The Fundraiser will notify Nonprofit of the need to retire the Service Dog. The Fundraiser will also notify Nonprofit of any changes of address. The Fundraiser will maintain contact with Nonprofit throughout the life of the Service Dog. If the Fundraiser is unable to keep the Service Dog, Fundraiser will return the dog to Nonprofit. The Fundraiser will not sell, give away, or dispose of the dog in any other manner. The exception is euthanasia for medical reasons at the advice of a licensed veterinarian.

In further consideration of Nonprofit providing the Service Dog, Fundraiser agrees to the amount to be raised on behalf of Nonprofit as set out in Exhibit A. The amount will be remitted to Nonprofit by the time the Service Dog is delivered.

The Fundraiser will allow photographs and story to be used by the Nonprofit.

Nonprofit recommends that the Fundraiser take obedience classes or private training with the Service Dog. These will help refresh training and to help with future training.

Disclaimer: Fundraiser understands and acknowledges that health, behavior (including training), and temperament cannot and will not be guaranteed, and funds will not be issued nor liability be accepted should Fundraiser decide that the temperament, behavior, or health is undesirable. Thus, the Service Dog is provided with no express or implied warranties or representations for health, behavior, or temperament. Nonprofit Service Dogs takes no responsibility or liability for the dog’s health, behavior, or temperament, and the Fundraiser agrees not to hold Nonprofit Service Dogs liable for any reason, including health, temperament, or behavior.

Hold Harmless: The Fundraiser agrees that the handling of any dog is potentially hazardous. Even with all duty of care and standards of training, these factors still do not give assurances of safety. Thus, you accept any hazard with the Service Dog. You will hold the Nonprofit harmless from any claims, damages or injuries from the dog. Any insurance requirements is the responsibility of the Fundraiser. The Fundraiser accepts full responsibility under law to take full care of the dog’s actions. The Fundraiser is responsible for the dog at all times and thus will ensure that the dog always adheres to the code of conduct. Neither party will be liable to the other for any damages. Neither party will be liable for any later action or omission on the part of the Service Dog. This provision applies whether liability is asserted in contract, tort (including negligence). This provision applies whether liability is asserted in strict liability or otherwise. This provision applies irrespective of whether a party has been advised of the possibility of any such loss or damage.

Binding Effect. Unless otherwise stated herein, all the provisions of this Agreement will be binding. The binding will apply to the heirs, estates, next of kin, executors, administrators, and assigns of the parties. The undersigned agrees that their signature is their authority to bind all household members to this agreement.

Entire Contract. This Agreement contains the entire understanding of the parties. The understanding is in regards to the adoption of the above-noted dog. There are no other representations, promises, warranties, covenants or undertakings.

Governing Law. This Agreement will be governed by the laws of the State of that the nonprofit is incorporated. The Agreement may not be altered, modified or rescinded unless agreed to in writing by both parties.

Venue. The Fundraiser agrees that any legal proceedings will be only in the nonprofit's state. The Fundraiser agrees to an option to mediate upon mutual agreement of the parties. If either party sues the other, the prevailing party will have the right to collect from the other party. Collections will be its costs, disbursements, and attorneys' fees paid to enforce this Agreement.

Good health cannot be guaranteed. If the Nonprofit cannot deliver dog because of dog’s death, Nonprofit will find and train another dog. The Nonprofit will apply fundraising made towards the cost of the new dog. If the Fundraiser does not want the dog before the end of training, no fundraising will be returned. In witness whereof, the parties have executed this Agreement on the date above.

Signature: ___________________________   Date: _________________

Fundraiser

Signature: ___________________________   Date: _________________

[Name of Executive Director], Executive Director, Nonprofit

Good Faith Fundraising for Service Dog, Exhibit A

Fundraiser agrees to raise donations for Nonprofit, a 501(c)3 organization. The schedule as follows. Please note, all funds raised or donated are non-refundable.

Deposit, due with the agreement, which will apply towards the final fundraising total.

First, due ________________, which will apply towards the final fundraising total.

Second, due ______________, which will apply towards the final fundraising total.

Final, due ______________, which will apply towards the final fundraising total.

 

 

Contract with Veterinarian

To be provided to service dogs in-training (expect 3-4 dogs per year):

1 - Courtesy initial exam and courtesy exam before placement.

2 - Spay/neuter surgeries, if needed, will be provided as a courtesy service.

3 - Core vaccinations (rabies and distemper) will also be provided as a courtesy service.

4 - The rest of the medical needs will be accounted under the terms of our Friends & Family Discount. The discount is that services and treatments are discounted at 50%. Inventory items are charged at cost plus 20%.

5 - Medical and behavioral consultation. Access to veterinary specialist consultation (radiology, cardiology, surgery, internal medicine, etc).

6 - Medical records and letters of the dog's examination will be provided to each service dog family.

7 - Access to the talents and relationships of our staff members. Examples include placement of dogs in need of homes in-home pet-sitting of your dogs-in-training.

8 - A treatment plan (estimate) for goods and services can be requested and discussed at any time.

9 - Payment is due in full at the time of service.

A 10% discount on services will be extended to the families who receive the Service Dogs. This arrangement may be extended to other service dogs at the discretion of the clinic.

Logistics of the Partnership:

1 - An account for the nonprofit has been created. All previous records and history will be provided to the veterinary clinic. This process will create a medical record for each service dog.

2 - _______ will be the point person for communications, exams, surgeries, procedures, and treatments. If that person is not available, one of the other veterinarians will manage medical care.

3 -  Any cross-promotional opportunities and advertising/marketing must receive approval from both parties.

4 - A request to the change of terms of the partnership can be discussed.

Signature of a representative of nonprofit, and date:

Signature of a representative of clinic, the date:

 

 

Criteria for Matching Dogs to Handlers

Applicant has completed application

Interview

Letter from doctor

Applicant has completed agreement

Applicant agrees to continue to train the dog

Applicant agrees to keep dog trained throughout its lifetime

 

 

Dog Feeding Chart (Weekly)

Dog’s Name:

Sunday dinner:

Monday dinner:

Tuesday dinner:

Wednesday dinner:

Thursday dinner:

Friday dinner:

Saturday dinner:

 

 

Fundraiser Sign-in Sheet

Name:

Email address:

Name:

Email address:

Name:

Email address:

Name:

Email address:

Name:

Email address:

Name:

Email address:

Name:

Email address:

Name:

Email address:

Name:

Email address:

 

 

Medical Form for Clients

The letter should be on the physician’s or medical provider’s letterhead.

Date:

To Whom It May Concern,

My patient is:

He/she has been under my care since the following date:

The patient has the following severe disability:

Due to this disability, I recommend a service dog to help with the following task:

Sincerely,

Doctor’s name and title:

 

 

Policy for Candidate Dogs on Health, Temperament, Task Aptitude, and Socialization

A veterinarian should check for:

__ Dog is of appropriate weight.

__ Ears are clean.

__ Eyes are normal.

__ Nose is normal.

__ Breath is good.

__ Teeth are clean.

__ Skin is normal.

Dog should be tested for:

__ Is the dog sensitive to noise?

__ Can the dog be handled all over its body?

Has the dog been evaluated for 30 days for signs of fear or aggression?

Is the dog able to do a task?

Has the dog passed a Candidate test?

 

 

Pre-Application

Note that none of the answers disqualify you. It's just nice for us to know what your situation is. Thank you for your patience with these rather personal questions.

What is your name?

What is the name of the person getting the service dog (if not you)?

What is the age of person getting the service dog?

Street Address:

City, State, Zip

Phone:

E-mail:

Does the person getting the dog go to school or work full-time?

Will the dog need to go to work or school?

_ Yes, the dog must go to work or school with the handler.

_ No, the dog doesn't have to go to work or school with the handler.

_ The handler does not work or go to school.

Household Information

What is your marital status?

Do you live in a house or apartment?

Do you have a fenced yard?

_ Yes, a standard 4-foot-high chain link fence

_ Yes, a 6-foot-high wooden fence

_ No

How many adults are in your household?

How many children are in your household?

If you have children, what are their ages?

Please list any pets you own and their ages.

Disability (please answer for the person getting the service dog)

What is your disability?

Do you have a secondary disability?

When did your disability start?

Do you have any of the following psychiatric conditions?

_ Agoraphobia _ Major Anxiety _ Post Traumatic Stress Disorder _ Depression _ Borderline Personality Disorder _ Dissociative Tendencies _ Obsessive Compulsive Disorder _ Panic Disorder _ Bipolar _ Schizophrenia _ Social Phobia

Do you have problems with any of the following?

_ Anger _ Apathy _ Confusion _ Crying _ Fearfulness _ Irritability _ Moodiness _ Panic _ Social Withdrawal

If the disability is autism, how much does the person with autism like dogs? (It IS okay if the person not that into dogs. It's just nice for us to know because it helps us match the right kind of dog for that person).

Are you receiving any government benefits such as SSI, disability, or veterans benefits? If so, please describe:

What is your annual family income (you and your spouse)?

If selected for the Service Dog program, you will be expected to fundraise. Some organizations do all the fundraising, but we ask that families raise at least half . This process helps ensure that they are vested in the process, plus we are a pretty small organization. Some families just write a check for their part of the fundraising rather than fundraise from friends and family. Yet we encourage even well-off families to fundraise. We believe that the process helps bring their community together and helps raise awareness of what the dogs do.

Do you have the financial resources to pay for half the fundraising for the dog if the fundraising efforts from your friends and family is not sufficient?

_ Yes

_ No

I understand that if I am accepted into the Service Dog placement program then I will commit to that dog. I will also follow the training instructions of the organization.

I recognize that the nonprofit gets many applications per day. I understand that I will probably not be contacted.

 

 

Programs and Services

Service Dog Placement Program

Mission: To adopt unwanted dogs and train them as service or therapy dogs.

What we are measuring: The number of dogs trained and placed with a handler.

Family Dog Program

Ensure that any candidate dog who is unsuitable for service dog work is adopted to a good home. The families who adopt these dogs enjoy the training the dogs have already received.

What we are measuring: Percent of dogs adopted to families as a family pet.

 

 

Release of Liability

Required of all volunteers, applicants, guardians, and caregivers.

In return for participation, I assume liability for my actions while working here. I understand that reasonable precautions will be taken to protect my safety. I release the staff and officers of all liability.

Name:

Date:

Signature:

Name of parent, guardian, or caregiver:

Date:

Signature of parent, guardian, or caregiver:

 

 

Training Program Policies

Handler

Handler agrees to give the dog food, exercise, water, and veterinary care. The dog will always be leashed, not left outside, nor brought to a dog park.

Training

The handler will continue the dog's training throughout its life.

 

 

Training Schedules, Plans, and Progress Reports

Note: Enter notes electronically, in MS Word.

Dog's Name:

Week #:

Stage 1 (Evaluation), Stage 2 (Manners), Stage 3 (Training), Stage 4 (Task Training), or Stage 5 (Public Access):

Health:

Temperament:

Socialization:

Manners:

Obedience:

For each skill, list distance, distractions, and duration:

Task training:

Outings (not public access):

Public access:

Problems:

Comments: