The below self-assessment is the first stage of applying for the Sunshine Coast Wishlist Therapy Dog Program.

First name *

Last name *

Phone *

Email *

Street Address *

Suburb *

City

State *

Postcode *

Dog's name *

Dog's breed *

Dog's sex *

MaleFemale

Dog's date of birth *

Is your dog up to date with vaccinations and preventative health care? * *

YesNoWill be soon

How does your dog behave around strangers? *

Relaxed, friendly, enjoys meeting new peopleHesitant at first but warms upNeutral / indifferent to strangersAnxious, avoids contact

How does your dog behave around children? *

Calm and comfortable with children of all agesTolerant with older children but less comfortable with toddlers/young childrenTolerant but prefers limited interactionNervous or unsettled around children

How does your dog behave around other dogs? *

Social and interacts politelyPrefers people but ignores other dogsTolerant if other dogs are calmOverly excited (pulling, barking for play)Reactive (barks, pulls, growls, or avoids)

Reaction to loud noises/unexpected movement *

Remains calm and unfazedStartles but recovers quicklyCurious / investigates the source of the noiseStressed, anxious, or unable to settle

Have you ever witnessed any signs of aggression? (can include growling, snapping, lunging/charging) *

Enjoyment of touch/handling (pats, grooming, hugs) *

Enjoys and seeks physical contactAccepts most handling but doesn’t actively seek itTolerates handling but prefers space at timesDislikes being handled, may avoid or resistActively resists handling (e.g. tries to escape, growls, or mouths)

Please share any extra information about your dog’s behaviour or temperament (e.g. situations where they do particularly well or find challenging).

Has your dog completed any formal training? (tick all that apply) *

Puppy SchoolBasic Obedience ClassesAdvanced Training ClassesPrivate Training with a Trainer or BehaviouristSelf-Trained at HomeNone of the above

What Training Cues/Commands Does Your Dog Already Know? *

Sit & StayDown & StayLeave itToilet on commandLoose leash WalkingGet on/get off furniture on command

Some therapy visits involve lifting, close handling, or lots of walking. Do you feel confident safely handling your dog in public settings? *

YesNo

What type of environments would you like to visit with your dog? *

HospitalAged CareSchoolsCommunity ProgramsOne on One VisitsOther

How frequently can you commit to visitations? *

Multiple Times Per WeekWeeklyFortnightlyMonthly

Are there any additional notes or comments?

I agree to the terms above.

Wishlist Therapy Dog Program Initial Self-Assessment