EPSD Therapy Dog Program: Student Preferences

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this short survey to indicate your comfort level with dogs. Please answer this on behalf of yourself only at this time.

Email *

Student name (first and last name) *

What is your student ID #?

What is your current grade level? *

Kindergarten

What school do you attend? *

Emmaus High School

LMMS

Eyer

Alburtis

Jefferson

Lincoln

Macungie

Shoemaker

Wescosville

Willow Lane

Required

Which of the following best describes your comfort level with dogs? You may select multiple, if necessary. Also, you may add comments in "Other" if you want to provide additional details about allergies or if your comfort varies based on breed/size of the dog. *

I am allergic to dogs, but only if I touch or come in close contact. I am comfortable being in the same room as dogs.

I am allergic to dogs and cannot be in the same space.

I do NOT want to interact with dogs throughout the day because of fears or other reasons.

Other:

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of East Penn School District. Report Abuse

Forms