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Name of Professional Dog Owner: _________________________________________
Name of Professional Dog Handler: ________________________________________
Name of Professional Therapy Dog: ________________________________________
Building in which therapy dog will work: ______________________________________
____Administrative Approval:
A signed statement reflecting administrator approval for use of a professional therapy dog.
_____Health Records:
A copy of annual vaccinations and exams signed by a licensed veterinarian including a photocopy of the rabies certificate. It is expected that all owners/handlers will use year-round preventative medication for heartworm/external parasites.
Note: for dogs less than one year of age, or receiving their first Parvo/Distemper and rabies vaccination, follow-up vaccines will take place in one year. For all other dogs, these vaccinations will take place every three years.
_____Public Access Test: Certificate verifying the owner/handler and dog have passed.
_____Current Certification Date: _________________________________________
Signature of Professional Dog Owner/Handler: ________________________________ Date: ________________
Signature of Building Administrator: _______________________________________ Date: ________________
Signature of Executive Director of Student Services: ____________________________ Date: _________________
Adopted: 8/17
Reviewed: 4/18; 6/21; 2/24
Related Policy: 604.2; 604.2-E2