Code No. 606.3E3 Professional Therapy Dog Vital Information

Professional Therapy Dog Vital Information

(All documentation to be filed in the building in which the Professional Therapy Dog’s owner works and with the Superintendent or the Superintendent’s Designee.)

Professional Dog Owner ____________________________________________________

Professional Dog Handler ___________________________________________________

Professional Therapy Dog ___________________________________________________

Secondary/Alternative Handler _______________________________________________

School (s) in which the dog will be used ________________________________________

Dog Handler’s Certification Date ______________________________________________

Name of Organization Certifying ______________________________________________

Date of Recertification_______________________________________________________

Emergency Contact Person and Phone No for the dog

  1. ______________________________________________________________
  2. ______________________________________________________________

Therapy Dog’s Veterinarian and Phone No. _______________________________________

Dog’s Date of Birth __________________________________________________________

Last Health Check ___________________________________________________________

Annual Worm Check _________________________________________________________

Bordetella __________________________________________________________________

Rabies Vaccine Date _________________________________________________________

Parvo/Distemper Date ________________________________________________________

 

Note:  Five-way Parvo/Distemper (DAPPv) updated annually and rabies vaccinations shall be updated every three years; dogs less than a year of age or receiving vaccinations for the first time shall receive follow-up in one year, with rabies vaccinations every three years thereafter.

Verification of preventative parasite control (fleas and ticks) as well as heartworm medication is given year-round.

 

Owner’s Signature

 

Approved: May 20, 2024

Reviewed/Revised: