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
- ______________________________________________________________
- ______________________________________________________________
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: