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Therapy Dog Program Setting Interest and Approval Form

The survey will take approximately 5 minutes to complete. Once submitted, our staff will review your request. Please allow up to two weeks for processing.

Canine Companions has recently launched our Therapy Dog Program in your area. Please fill out this form if you are interested in having Certified Therapy Dog teams visit your setting. Teams are required to have approval before visiting all settings.

Canine Companions is a non-profit organization that enhances the lives of people with disabilities by providing highly trained service dogs and ongoing support to ensure quality partnerships. While our mission is to provide highly trained service dogs to people with disabilities, we believe the dogs released from our program can still have an incredible ripple effect in the world through their work as therapy dogs. With this goal in mind, we created this program to certify our amazing dogs to have an opportunity to provide support and comfort to members of our community.

While working, our Canine Companions Certified Therapy Dog Teams are covered by our liability insurance. The details are as follows:

Canine Companions' limits are $1 million per occurrence on Commercial General Liability; $1 million Automobile Liability (coverage that is secondary to their personal auto policy). Canine Companions does not provide physical damage coverage for the volunteer’s personal automobile. Additionally, a $10 million Umbrella Liability policy increases the liability limits of Commercial General Liability and the Automobile Liability. Canine Companions reviews these limits for adequacy on an annual basis.

Thank you for completing the information below:
1.What is the name of your setting or event?(Required.)
2.What type of setting is this?(Required.)
3.What is the full address? Please include city, state, and zip code.(Required.)
4.Please provide a description of your setting or event that we can share with therapy dog handlers (this can include details about the space they will using and who the dog will be interacting with. For example, adults or children, large groups or one on one, etc.).(Required.)
5.What frequency would you like to request therapy dog visits?(Required.)
6.Please choose one of the following:(Required.)
7.Do you currently have an established therapy dog program at your setting?(Required.)
8.What is your role at the setting?(Required.)
9.Please provide your name.(Required.)
10.What is your contact information (phone number and email address)?(Required.)
11.Are you the person who provides approval for therapy dogs to visit your setting? If not, do you have permission to provide approval?(Required.)
12.I am approving Canine Companions to provide this setting's contact information to certified therapy dog teams who are interested in visiting this setting.(Required.)
13.Do the teams need to attend an orientation specific to your setting? If so, please explain.(Required.)
14.Are there specific days, dates, or times that you're looking for therapy dog team visits?(Required.)
15.Are you open to having visits on evenings and weekends?(Required.)
16.I understand that by submitting this form it does not guarantee that therapy dogs will be available to visit at the date(s) and times(s) for which I'm submitting this request.(Required.)