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Facility/Therapy Dog Client Inquiry Form

To be eligible to become a PADS facility/therapy dog client, you must be at least 18 years of age. You must also live in British Columbia, Alberta, Saskatchewan or Manitoba. At least one person must be primarily responsible for the dog�s care and handling.

The information you provide on this form is confidential and will be used by Pacific Assistance Dogs Society staff only.

*Required
Date
*First Name
*Last Name
Organization/Facility Name (if applicable):
*Address
*City
*Province
*Postal Code
*Phone
*Your email address
Please describe your practice and/or care facility::
Please describe how you think a PADS Facility/Therapy Dog will help you in your practice/facility: