Animal Assisted Therapy Application

You and your best friend can bring a smile to patients during their stay at Elmhurst Memorial Hospital. We welcome your application for participation in our Animal Assisted Therapy Program if you are at least 18 years of age, and if your dog meets the following criteria:

  • Your dog sits and lays down with only one command
  • Your dog stays until you call him or her with only one command
  • He or she walks loosely on a leash and doesn't pull, even when excited
  • Your dog is friendly with other dogs
  • Your dog will perform commands without treats as a reward

We have other requirements, too, that will help you, your pet and our patients enjoy the Animal Assisted Therapy experience.

Your dog should:

  • Enjoy people
  • Not bark or whine
  • Be at least a year old
  • Be up-to-date on all vaccinations, including rabies
  • Not have any skin problems

We also ask that you do not use prong collars, gentle leaders or retractable leashes, and that you and your dog have completed a group obedience training class within the past six months.

Interested in donating to our Animal Assisted Therapy Program? Click here. Be sure to note in the comment field that your donation is for the Animal Assisted Therapy Program.

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General Information
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All volunteers are required to work minimally once every other week. We currently have the following shifts (Check all that apply):


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Have you ever done dog therapy work with your dog named on this application?

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Are you currently Therapy Dog Certified?

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Enter date MM/DD/YYYY
Dog Information
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Enter date MM/DD/YYYY
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Gender

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Spayed/Neutered?

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Has your dog attended group obedience classes?

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Is your dog currently on year around Flea Protection?

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Does your dog live with you?

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Volunteer Shifts
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Are you a year around resident at the address listed above?

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Exclusivity Agreement
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