Moment to Paws application form

Thank you for your interest in joining Moment to Paws as a therapy dog handler team. Our number one aim is to make sure that the dogs we work with are kept safe and happy at all times. This questionnaire has been developed to make sure that you and your dog will be well suited to joining us on our exciting workplace visits.

Please answer all questions in this application form as honestly as possible.

Should you be successful at this stage, you will be invited for an informal chat during which your dog will be further assessed and you will have the opportunity to ask any questions.

Please note that the majority of our events take place across Yorkshire and Manchester, and interviews will take place near Wetherby, West Yorkshire.

If you have any questions before completing this application form, please email kate@momenttopaws.co.uk.

Best wishes,

Kate Soames

Founder | IMDT | A Dip. CBM
Your details
Name

First NameLast Name
Email
example@example.com
Phone number
Address

Street Address

Street Address Line 2

CityState / Province

Postcode
What interests you about this role?
Please provide a brief summary of any experience you have that you believe will help you to be successful in this role.
What body language does a dog give which communicates that they are uncomfortable / stressed?
Moment to Paws events take place between Monday and Friday (timings vary). Please let us know if there are any days that you are not available on a regular basis.

About your dog
Your Dog's Name
Breed
Age
How old is your dog? Please note that your dog must be at least one year old.
Age When Obtained
Please write 0 if it was at less than one year of age
Sex

Male - not neuteredMale - neuteredFemale - spayedFemale - not spayed
How would you describe your dog's personality?

Medical information
Registered Vet
Vet Phone Number

Area CodePhone Number
Vet Address
Please give a brief medical history, especially recurrent problems and treatment.
Is your dog up to date with all standard vaccinations (Parvovirus, Canine distemper, Leptospirosis, Infectious canine hepatitis, Kennel cough)?

YesNoOther
Is your dog's worming treatment up to date?

YesNo
Is your dog's flea treatment up to date?

YesNo
Is your dog currently on any regular medication?
If yes, please provide details

Thank you for your interest in working with Moment to Paws!

Please check the statements below before signing in the box and clicking submit. Your application will be reviewed within 5 working days and we will be in touch to discuss next steps.
I confirm that the information I have provided to Moment to Paws in this questionnaire is accurate to the best of my knowledge and that I have told Moment to Paws about all current or ongoing problems with my dog’s health or temperament. I also confirm that my dog has received all necessary vaccinations and is up to date with worm and flea treatments.
Signature

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Date

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Date
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Your details