PTO ANNUAL MEMBERSHIP RENEWAL
Renewal fee is $35 for an individual member or $45 for a family membership (family members must be 18 years old or older and reside at the same residence). Membership fee is due by September 30.
Name
*
First Name
Last Name
Family Member Name (ONLY IF SUBMITTING FAMILY MEMBERSHIP RENEWAL)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Family Member Phone (ONLY IF SUBMITTING FAMILY MEMBERSHIP RENEWAL)
Please enter a valid phone number.
Email
*
example@example.com
Family Member Email (ONLY IF SUBMITTING FAMILY MEMBERSHIP RENEWAL)
example@example.com
Homeowners or Rental Insurance Carrier
*
Would you be willing to serve as a mentor to a new pet therapy team?
Please Select
Yes
No
List any skills you have that would help PTO (i.e. accounting, graphic design, woodworking, web design, hard worker, enjoy making phone calls, etc.
Which event(s) can we count on you to help with to benefit the organization?
PTO workshop
PTO evaluation
Special events (i.e. stress relief visits to local colleges during finals)
Training events
Celebration dinners
Other
PET INFORMATION
Pet #1
Pet Name
Breed
Rabies Tag Number
PTO Tag Number
Pet #2
Pet Name
Breed
Rabies Tag Number
PTO Tag Number
If you have more than two certified pets, please list your additional pets below. Please include pet name, breed, rabies tag #, and PTO tag # for each pet.
Veterinarian Name
Veterinarian Phone Number
Please enter a valid phone number.
ANNUAL FACILITIES UPDATE
Please list all locations you currently visit. Include the facility name, day of the week you visit, time of day you visit, and the pet's name that makes the visit.
Example: Republic Library, 1st Thursday of the month, 4:30 pm, Fido
Signature - Your signature on this form verifies that immunizations will be given to your PTO pets as required during the coming year. Failure to renew by September 30 will result in suspension of visiting privileges. Your signature also verifies that you will maintain liability coverage on either homeowners or renters insurance.
*
Family Member Signature (ONLY IF SUBMITTING FAMILY MEMBERSHIP RENEWAL) - Your signature on this form verifies that immunizations will be given to your PTO pets as required during the coming year. Failure to renew by September 30 will result in suspension of visiting privileges. Your signature also verifies that you will maintain liability coverage on either homeowners or renters insurance.
Back
Next
Pet Therapy of the Ozarks - Rules of Conduct for Visits
Please read the Rules of Conduct and sign below to indicate that you have read this document.
Handler and pet must pass the Pet Therapy of the Ozarks evaluation before being scheduled for visits.
Volunteer teams visit only approved facilities and places within them at pre-scheduled days and times. If, while making such a visit, a team is asked to visit another area within the facility, our insurance allows us to do so provided the person making the request has authority to do so.
Pets must be clean and well-groomed and free of internal and external parasites. Nails must be kept short to avoid scratching PTO clients. Animals must be in good health and free from any sign of gastro-intestinal disease for one week prior to PTO visit. Also female pets in season should NOT be taken on PTO visits.
Pets MUST wear PTO identification and rabies tag when working as a therapy pet. The pet’s PTO identification tag is to be worn ONLY ON SCHEDULED VISITS. Human volunteers MUST wear their PTO name badge during visits. Wearing the identification tag or name badge on an unapproved visit is a violation of PTO rules and is prohibited.
Potty your pet prior to the PTO visit. Carry a potty bag on all visits. If an accident happens, you must clean up after your pet both indoors and outdoors.
Dogs MUST be kept on a leash at ALL times during PTO visits, except when doing obedience demonstrations or tricks. Other animals must be kept under control, leashed, carried in carriers, and not running free. DO NOT PASS YOUR LEASH TO SOMEONE ELSE.
Do not force your pet into a situation if it shows obvious fear or agitation. If your pet is showing signs of stress, immediately remove yourself from the facility. Either call the facility or go back in without your pet and excuse yourself from the visit.
No abuse or harsh treatment of pets will be tolerated. Avoid loud reprimands. If your dog must wear a pinch collar, it must be covered with a scarf, as the public is often upset by them.
Do NOT place pets on the beds or in laps without permission.
State law prohibits animals in the kitchen area or dining area whether or not a meal is in progress. Do not take your pet into such an area, even if requested to do so.
If you have ANY incident involving a nip, bite, or any destruction of clothing or other items, immediately remove your pet from the facility and notify (1) your facility contact AND (2) a PTO board member.
Photos showing client faces must not be shared to social media - even if a client/client guardian gives permission. If a facility posts photos of faces on social media, those may be shared.
Members may certify more than one pet, but only one pet per member may be taken on a scheduled visit.
PTO members are required to make a minimum of one scheduled visit per month. Members are encouraged to volunteer and participate in Special Visits when they occur.
Pets must have a current rabies certificate according to City of Springfield regulation, regardless of residence. The PTO secretary must keep a copy of rabies certificate. A copy of the pet’s shot records MUST be submitted each year with a renewal. Dog owners are required to show proof of immunization against distemper, parvovirus, and Bordetella. Cat owners are required to show proof of FVRCP. PTO will also accept a positive titer.
FAILURE TO PROVIDE RENEWAL INFORMATION BY SEPTEMBER 30
OF EACH YEAR WILL RESULT IN SUSPENSION OF VISITS.
Members making visits to facilities must maintain liability coverage on either Homeowners or Renter’s insurance.
Always be dependable. Patients and staff are disappointed if they are expecting a visit from a pet, and it is late or does not appear. It is also an embarrassment to the organization and harms our credibility with the facilities we serve. If you find you are unable to fulfill your scheduled visit, notify the facility and the Facilities Director.
Members must be willing to conduct supervised visits when needed and volunteer/attend training events, community events, membership celebration meetings, and the biannual workshop and evaluations when possible.
Signature
*
Family Member Signature (ONLY IF SUBMITTING FAMILY MEMBERSHIP RENEWAL)
Back
Next
ADDITIONAL REQUIRED DOCUMENTS
Please upload a copy of your current rabies certificate and current shot record for each of your certified pets. It would be helpful if you file names included your last name, your pet's name and the type of document (i.e. Smith Fido Rabies, Smith Fido Shots).
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Membership Renewal Fee
prev
next
( X )
Individual Membership
$
35.00
Quantity
1
2
3
4
5
6
7
8
9
10
Family Membership
$
45.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Continue
Continue
Should be Empty: