Therapy Animal Reading Program
Sign in to Google to save your progress. Learn more
Dear Parents/Guardians:    The North Liberty Library will be participating in the Living Creatures Ministry’s Therapy Animal Reading Program. This Program at the library will pair therapy animals and their handlers with individual children for one-on-one reading time. Therapy animal programs have been proven to reduce anxiety, improve test-taking abilities, and help many children increase their oral reading fluency. This program is offered at no charge to you.
This form serves as notice that there will be LCM Therapy Animals on site at various times. Your child’s participation in the LCM Program will not begin until your written permission is received. You have the right to refuse participation in this program. By signing this form, you also give your permission for your child to be photographed by LCM and the library for use in publicity and on social media.
In addition to signing below, please indicate (by selecting the appropriate option), whether your child is allergic to dogs or other animals. In the interest of your child’s safety, if your child is allergic, we cannot offer participation to your child in the program.
If you have any questions or concerns about the program, please contact the library at khodgson@northlibertyiowa.org or the LCM Coordinator at Good Shepherd Lutheran Church, Tricia Andersen at tricialynetteandersen@gmail.com.
I give permission for my child, _________________, to participate in the Therapy Animal Reading Program. *
Type child's full name below.
Is your child allergic to dogs and/or other animals? *
Parent/Guardian Signature *
Type your full name below to serve as your legal signature for this form.
Please enter today's date. *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy