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A Resource for Pets and Their People

Apply at T.A.A.P.

Therapy Animals Assisting People

11875 McArthur Lane - George, KS 66535

Name: ____________________________________________ Date: _______________________

Address: __________________________________________ Date of Birth: ________________

City/State/Zip: _________________________________________________________________

Home #: ___________________ Work #: ____________________Cell #:__________________

Drivers License #:_________________________________ State: _________ Expires: ________

How many people live in your home: ____ What are their ages: __________________________

Are you applying for a therapy animal for ___ yourself _____ a family member ___both?

Please tell us about the disabilities of each person you are applying for (including yourself, use additional paper if needed):

Name: ________________________ Disability: __________________________________________

Age: _________ Is this person on medication? If so what?: ____________________________

Name: ________________________ Disability: __________________________________________

Age: _________ Is this person on medication? If so what?: ____________________________

Do you ___ own ___ rent? If you rent, Landlords name: _____________________________

Address: _______________________________________ Phone: ___________________________

City/Sate/Zip______________________________________________________________________

We will be happy to provide a letter to your landlord regarding your therapy animal(s) if one is needed. Our therapy animal(s) should be given the same consideration as other service animals with regard to your living accommodations as provided in the Fair Housing Act( 42 U.S.C. 3601) and the Americans with Disabilities Act of 1990.

Please tell us about all animals you own, include therapy animals: (use a separate piece of paper if needed)

1) Pet Name: _____________________ Description: ______________________________________

___ M ___ F Spayed/Neutered? ____Yes ____ No Current on Shots? ___Yes ___No Age: _______

2) Pet Name: _____________________ Description: ______________________________________

___ M ___ F Spayed/Neutered? ____Yes ____ No Current on Shots? ___Yes ___No Age: _______

Veterinarian: _______________________________________________ Phone: _________________

Please tell us why, you feel your animal would make a good therapy animal AND/OR why you are requesting a therapy animal:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

In case of an emergency who should we contact?

1) Name: ____________________________________________ Relationship: ______________

Address: ______________________________________________________________________

City: ___________________________ State: _____________ Zip: ______________________

Home: _________________________ Work: ___________________Cell:__________________

Have you ever been convicted of a crime (other than minor traffic violations)? ___ No ___Yes

If yes please explain___________________________________________________________________

____________________________________________________________________________________

I understand that TAAP DOES NOT allow its therapy cats to be declawed and should I have a therapy cat by signing below I agree to this condition. I further understand that TAAP requires all of its therapy animals to be spayed/neutered when age appropriate and kept current on all vaccinations, including but not limited to rabies, and that these requirements are at my own expense. I also understand that all TAAP animals must be provided with food, water, shelter and love at all times. By signing below I agree to all TAAP conditions and state that all information on this application is true and correct. I understand that by signing below I am agreeing to these provisions and understand that if I don’t follow them TAAP can/will remove any/all TAAP provided therapy animal(s) from my care and terminate my participation in the program.

Signature of Applicant: ______________________________________________ Date: ____________

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TAAP Use Only Application received: _______________

Home visit completed on: ________________________________

# Therapy Animals: ___ Cat ___ Dog ___ Bird ___ Other _____________________________________

Current on shots? ___Yes ___No Why not _______________________________________________

Shots due next __________________________

Initial Application ___ Approved ___ Denied: Reason: _______________________________________

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