CONSENT AND RELEASE OF LIABILITY FOR ANIMAL ASSISTED THERAPY
Therapy animals can be a vital part of the treatment team; I hope that you are comfortable with Bella’s presence in your sessions. However, because she is an animal, and not a human, we are responsible for her welfare. In addition, because she is an animal, her behavior cannot always be predictable. Therefore, it is important to discuss in advance the risks and rules needed to insure Bella’s and your safety and health, and try to create as safe a working situation as possible. In addition, it is important to provide you with diligent warning about the potential harm that could be present when working with animals.
While I have listed some of these risks below, we cannot foresee all potential problems that may occur. Therefore by signing this form you are releasing Kara Bates, MA, LMFT from any liability should any injury occur as part of your treatment here.
1. Animals have their own natural defenses. While I will do everything possible to prevent any injury, it is possible that someone will get scratched or bitten.
2. Animals often use their mouths in play. Therefore, even when playing, it is possible for light biting to occur. When playing with a toy with Bella, she may miss the toy and get your finger. When she realizes this, she releases and does not bite down, but you may still feel her teeth.
3. While Bella has been screened by a veterinarian before commencing to work as a therapy animal, animals do sometimes carry disease. Because your contact is minimal, this risk is very small. Bella is up to date on all of her vaccinations.
4. While Bella is a “hypoallergenic” dog (as she has hair and not fur) there may still be risk for allergic reaction. Please let me know if you typically have allergies to animals.
1. Animals have individual rights, just as each client has rights. Therefore, Bella is allowed to determine if and when she participates with others. While it may be planned to have her in session, she will never be forced to do so.
2. Bella has her own quiet space in the office where she can rest, sleep, or just take a quiet break. She should not be disturbed when she is in this area.
3. Bella should always be treated gently. She should never be hit, have her tail or any other parts pulled, be carried or treated in any other way that is uncomfortable to her.
4. Bella will always need me present in any therapeutic situation.
5. If Bella becomes irritated, scared, or in any way acts in a negative manner, I will put her in a safe place. No other person should touch her at these times.
6. Bella can only be carried by her therapist handler.
7. Because of the unpredictability of animals in unfamiliar situations, clients may not bring their own animal to be involved in their therapy session.
8. Parents or guardians of children under the age of 10 must remain on the premises during their child’s session.
By signing below you are stating your acceptance of these rules and risks and agree to accept full liability in the event that Bella harms you or your child in any way in the course of treatment or you or your child is harmed in any way as a result of being on the property of 1333 W. 120th Ave. Ste. 300, Westminster, CO 80234 or at any other place while in the presence of Kara Bates, MA, LMFT and Bella.