Residential Companion Dog Application

Residential Companion Dog Application

COURTHOUSE COMPANION DOG APPLICATION

SECTION 1

Facility Name: ______Date: ______

Representative of Facility (name and title): ______

Thank you for requesting a courthouse companion dog application. The Canine Partners for Life courthouse companion dog program was established in 2009. Courthouse companion dogs are placed with a courthouse or related facility to provide emotional comfort and support to victims of crime and others affected by the stressors of the judicial system. A courthouse companion dog is usually placed with a county district attorney’s office and lives with a staff member from that office during non-working hours.

Dogs chosen for the courthouse companion dog program complete one year of training within a volunteer puppy home and are obedience trained and socialized in the same manner as a full service dog. At the end of the first year a courthouse companion dog is then placed in the home of a volunteer trainer who works closely with CPL trainers to focus on skills needed specifically for the facility’s placement. Dogs placed within the facility are typically about two years old.

Facilities requesting a courthouse companion dog need to complete an application and attend an interview at Canine Partners for Life. In addition, visits will be made by CPL staff to the courthouse/facility. A central, supervisory staff member needs to be involved throughout this entire process. When the decision has been made that CPL will be able to service the facility’s needs, a dog will be chosen based on those needs. When the dog’s training is complete all staff members who will be handling the dog in any capacity (a minimum of three individuals), need to attend four training sessions before placement will be made. These training sessions will focus on obedience skills, visitation skills and health care skills.After placement and for the duration of the placement there must be a trained staff member present anytime the dog is working. The typical waiting period for a courthouse companion dog is one to two years.

CPL provides regular follow-up phone calls and visits to the facility following placement and staff trainers are available for consultation at any time. At least one staff member of the facility, along with the companion dog, is required to attend at least sixobedience classes within the first year of placement and at least one training class per year throughout the entire placement. Failure to attend these classes may result in the facility

SECTION 1 CONTINUED

Facility Name: ______Date: ______

Representative of Facility (name and title): ______

being required to return the dog. Regular preventive and as needed veterinary care, in addition to all grooming and food expenses, are the responsibility of the facility.

There is a $25 non-refundable processing fee that must be included with the application. Once the application has been reviewed, an initial interview will be scheduled.

Canine Partners for Life is an accredited member of Assistance Dogs International. CPL respects the privacy of its applicants and recipients and all information is kept confidential although files may be periodically reviewed by accreditation agencies to ensure CPL’s commitment to the highest standards of excellence in the assistance dog industry.

Canine Partners for Life conducts its business and acceptance process in a manner that will not discriminate against anyone on the basis of race, color, religion, gender, national origin, age, the presence of mental or physical disability, sexual preference, life expectancy, or whether the individual is a disabled veteran or veteran of any era. It is Canine Partners for Life’s policy to treat everyone who comes in contact with the organization with respect and dignity at all times.

At no time will Canine Partners for Life require applicants, students, or graduates to participate in fundraising or marketing activities.

I have read, understand, and agree to SECTION 1 of this application (please initial): ______

SECTION 2

Facility Name: ______Date: ______

Representative of Facility (name and title): ______

What to expect when you apply for a courthouse companion dog:

  • To travel, at your expense, to CPL for an interview. Allkey staff should attend the interview.

What to expect following the interview:

  • To create a care plan for the dog which will include: care-givers’ positions, procedure for night and weekend care, plan for the dog to be taken off of the premises for rest and relaxation, plan for controlling treats, plan for routine and emergency veterinary care, etc.

What to expect if accepted to waiting list:

  • CPL staff members will visit the facility for a full tour.
  • To wait approximately one to two years to be matched with a dog.
  • Three staff members (additional staff members are welcome) will be required to attend training classes and an orientation at the CPL facility.When a trained staff member leaves the facility or program, a replacement must be trained within 60 days. These three staff members will attend four training classes and an orientation before a dog will be placed in the facility. One of these three individuals must be designated as the coordinator of the facility’s courthousecompanion dog program.
  • Any staff member wishing to take the dog home for rest and relaxation must complete the CPL training listed above.

What to expect when a dog is selected:

  • To purchase basic supplies for the dog - cost approximately $200.
  • For the potential dog to make several short visits to the facility before a final placement decision is made.
  • On the day of placement, to schedule several hours for CPL staff and facility staff to meet to discuss your dog, receive instructions on training and dog care, and for a training session.
  • To provide a requested $600 donation to CPL at the time of placement.
  • Each handler will receive a copy of the courthousecompanion dog transfer agreement and a copy will be placed in a designated area of the facility.

What to expect after your placement:

  • The dog and a handler must attend six training classes at the CPL campus within the first year of placement and at least one obedience class per year for the duration of the placement.
  • Follow-up by phone daily for the first week, weekly for the first month, monthly for the first six months and as needed throughout the entire placement.
  • Monthly written follow up reports must be provided to CPL for the first year, including a daily log of the dog’s activities. After the first year these reports are required once every 6 months for the active working life of the dog.
  • To allow an adjustment of approximately one to two months for your dog to become acclimated to your facility.

SECTION 2 CONTINUED

Facility Name: ______Date: ______

Representative of Facility (name and title): ______

What to expect after your placement continued:

  • To attend a mandatory CPL graduation ceremony. This allows the volunteers and donors involved in your dog’s training to be acknowledged. Graduation is held twice annually on Sunday afternoons in either June or July, and again in November. Your dog should wear to graduation all training aids provided at the time of placement.
  • To maintain current veterinary health care according to CPL guidelines. Other health responsibilities/expenses include monthly heartworm preventives, flea preventives, necessary vaccinations, grooming and emergency veterinary care.
  • The dog must be fed one of the CPL approved foods. Food will cost approximately $60 per month.
  • The dog’s weight will be closely monitored. Excessive weight gain may result in the mandatory return of the dog to CPL.
  • To complete certification tests in accordance with CPL policies.
  • To retain current certification through CPL.
  • Follow up training support is always available from CPL staff.
  • To join the CPL family for life!

What to expect from your dog:

  • Courthouse companions are well socialized pets with reliable housebreaking and good basic obedience. They are not trained to perform physical tasks such as retrieval.
  • Courthouse companion dogs do not have public access under the Americans with Disabilities Act and may not be represented as service dogs for access to public facilities and housing.
  • Courthouse companion dogs must always be held on leash or kept in a securely fenced area with direct supervision when outdoors.
  • Courthouse companion dogs must be under direct staff supervision when interacting with clients.

I have read, understand, and agree to comply with SECTION 2 of this application

(please initial): ______

SECTION 3

Facility Name: ______Date: ______

Representative of Facility (name and title): ______

Address:______

______

County:______

Primary Contact Person: ______Office Phone:______

Cell Phone: ______

Email: ______

District Attorney: ______Office Phone:______

Cell Phone: ______

Email: ______

Facility Fax Number: ______

Number of Staff at this facility: ______

Upon mentioning the idea of a courthouse companion dog to staff and residents, have you had any resistance or objections?______If yes, please describe concerns:

______

______

In what area of the facility and in what capacity do you anticipate the courthouse companion dog working?

______

______

What staff person will provide direct supervision of the courthouse companion dog?

______

SECTION 3 CONTINUED

Facility Name: ______Date: ______

Representative of Facility (name and title): ______

Who will be responsible for taking the courthouse companion dog to the veterinarian, providing bathing, nail trimming and ear cleaning?

______

Who will be responsible for the feeding, watering, walking (5 times per day) and daily brushing of the courthouse companion dog?

______

Have any of the staff members who will be in direct contact with the dog ever been convicted of a misdemeanor, summary offense, or felony related to the abuse, mistreatment, neglect or harm to animals? ______Yes ______No

If yes, describe in detail including the state and date in which the conviction was made: ______

______

______

______

Who referred you to CPL? ______

I have read SECTION 3 of this application and to the best of my knowledge this information is true and correct.

Signature – Facility Director:______

SECTION 4

Facility Name: ______Date: ______

Representative of Facility (name and title): ______

Please include with the application the following:

1. PROMOTIONAL MATERIAL (brochures, newsletters, etc.) describing your facility.

2. A LETTER FROM A LOCAL VETERINARIAN OF YOUR CHOICEsaying that they will be caring for the dog’s health and will cooperate with CPL’s follow up when we ask to review the dog’s records. We will make arrangements to have the dog’s health history sent to your vet.

3. A BRIEF ESSAY explaining why you feel that a courthouse companion dog will be

beneficial and therapeutic for your facility. Include information about specific areas or programs where you foresee the dog participating and a description as to how you envision the dog interacting and with whom.

4. LETTERS INDICATING SUPPORT for the Courthouse Companion dog placement from the District Attorney.

5. $25 NON-REFUNDABLE APPLICATION PROCESSING FEE

SECTION 5

Facility Name: ______Date: ______

Representative of Facility (name and title): ______

Canine Partners for Life

Complaint Policy for Non-employees

Any non-employee (volunteer/applicant/student/recipient/donor) who has a grievance concerning CPL practices has the right to file a complaint according to procedures outlined in this policy. Grievances may include, but are not limited to, a perception of violation of rights; quality of service; discrimination based on category of race, age, disability, etc.; or other matter.

Complainants are treated with dignity and respect at all times, regardless of the nature of their complaint. They will not be discriminated against, harassed, intimidated, or suffer any reprisal as a result of filing a complaint or participating in an investigation of a complaint. If an individual feels that he or she is being subjected to any of the above, that person has the right to appeal directly to the Executive Director.

Affected parties should attempt to resolve the problem informally as soon as possible. Volunteers should discuss issues with the Volunteer Coordinator, donors with the Director of Development, and applicants/students/recipients with their trainer. If a solution cannot be reached, the person may present a formal complaint, in writing, to the Executive Director. Following the same protocol, complaints about the Executive Director should first be brought to her attention and then to the Board President if necessary. The President may be reached through CPL’s mailing address. Formal complaints and responses to them will be documented and kept on file.

All complaints are handled in a timely manner. As a goal, CPL attempts to resolve a complaint within 20 working days from the time of its initiation. If an extension of the time limit becomes necessary, all involved parties will be notified.

I have read, understand, and agree to SECTION 5 of this application:

Signature – Facility Director:______

Return this complete application along with the items listed on page 8 to the address noted below. Please allow 2-3 weeks for processing. If you have further questions regarding the Canine Partners for Life application or courthouse companion dogprogram, please call (610) 869-4902 x 212.

Canine Partners for Life, P. O. Box 170, Cochranville, PA19330

  Fax (610) 869-9785

Canine Partners for Life Courthouse Companion Dog ApplicationPage 1 of 8

Revised 9/2016

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