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Therapy Animal Request Form

A therapy animal provides therapeutic support to people other than its handler. Therapy animals do not have federally granted legal access to the types of public areas afforded to service dogs. In order to have receive permission to bring a therapy animal to your school, please fill out the following form. (THIS FORM HAS TO BE SUBMITTED WITH PROPER PAPERWORK EVERY NEW SCHOOL YEAR)

  • Proof of Liability Insurance
  • Therapy Animal Certification
  • Handler Registration and / or Handler ID
  • Vaccination Record
  • A copy of the current Animal Health Screening from a local veterinarian
It is clean, well-groomed and does not have an offensive odor - Does not urinate or defecate in inappropriate locations - Does not solicit attention, visit or annoy any member of the general public - Does not vocalize unnecessarily, i.e., barking, growling or whining - It shows no aggression towards people or other animals - Does not solicit or steal food or other items from the general public

Appendix: Information for Handlers / Owners requesting a therapy dog in school

I. The success of the implementation of a therapy animal program that is tied into the curriculum depends on clear communication, a well-informed school community and careful planning. The information you provide will assist the school principal and ADA Manager to make the best possible decision. The information will be filed in your Douglas County record as well as in your record at school.

I understand that I am required to participate in meetings requested of me by the school principal.

I understand that for the safety and protection of students and staff, which is necessary for the safe operation of the school, the school may revoke access because:

  • The therapy animal is not under control at all times.
  • The therapy animal is not housebroken
  • The therapy animal is not on a leash or tether at all times
  • The therapy animal poses a direct threat to the health of any student, staff member or any other person at school.
  • The therapy animal presence otherwise interferes with the educational program.
  • A staff member or student shows anxiety while the therapy animal is present.
  • The handler brought the therapy animal to school without prior submitting and authorizing appropriate paperwork to the ADA Manager.
  • The handler fails to follow the permission procedure and the school principal's instructions.

I understand that, I am the therapy animal handler and I am solely liable for any damage to persons, premises, or facilities that were caused by the therapy animal. I will hold the district, its employees or agents harmless for any injury to, including death of, the therapy animal, unless the damages are a result of gross negligence on the part of the district. In this case, liability to the district for damages is limited to property damage and veterinary costs.

II. The information you provide will help the school principal and appropriate staff to implement your request. It is important to provide the information that addresses the safety of the students and staff. For example, the school principal needs to know that the animal has no history of nipping, biting, or growling at children or adults, nor exhibits aggressive protective behaviors.

III. The well-being of the animal is very important. Its care, handling, and training needs to be addressed, and your input as the handler is valuable. The school principal also needs to know what other resources are available to facilitate the transition to school and the implementation of the plan. Strategies for becoming familiar with the building and school grounds, and introduction to staff rooms (if applicable) must be included in the planning to be as consistent and fair to the animal as possible. NOTE:  A school is not a training facility for therapy animals that have not finished their training. The training itself needs to happen outside of school. The handler needs to be in full control before a transition training with the animal can be considered and integrated in the plan.

IV. The school principal, with assistance, will develop a communication plan that informs students, staff and community members as appropriate. 

V. Once the necessary information has been received, the school principal will consult with the ADA Manager, prior to admittance and implementation of the therapy animal program. The ultimate decision of offering a Therapy Dog Program will lay with the school principal.