Operation K9 Beethoven Therapy Dog Application
Our objective is to form a network of caring individuals and their personal therapy dogs who are willing to spread joy and happiness by visiting veterans homes, rehabilitation centers, hospitals, etc. 
Sign in to Google to save your progress. Learn more
Email *
Dog Handler Full Name and Address *
Cell Phone Number *
Dog Name,  and Breed *
Therapy Dog Certification Company and ID number if applicable.  If not, write N/A currently in training. *
Are you currently, or have you previously trained with Chris Nolting? *
Required
Is the dog certified to work with? Please check all that apply.
Is the dog up to date on all shots and vaccines? *
Required
How often do you think you will be able to visit? *
Required
Are you aware of and understand HIPAA Privacy Laws?  HIPAA - the federal Health Insurance Portability and Accountability Act - provides protections for patients' privacy rights. *
Required
Would you be willing to attend Parades and Operation K9 Beethoven Events? *
Required
Are you comfortable with yourself and your dog being photographed and posted to Operation K9 Beethoven's media pages? i.e. website, facebook, instagram, twitter, tiktok, etc.
Are you comfortable with visiting severely disabled patients? *
Required
Please fill out this section if you did NOT train with Chris Nolting.  Please provide three references from Veterans homes, rehabilitation centers, hospitals, etc. that you have visited with your therapy dog. *
To the best of your knowledge, has this dog ever bitten anyone?
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy