Therapy Dog Program Release Form
Research has shown that therapy dogs in autism centers and schools can increase reading skills (childrenreading to the dog), as well as contribute to social and emotional development. A Therapy Dog’s presence has also been shown to reduce anxiety, help children work though anger management, increase social/communication deficits and increase development of relationships. The specific goals of the NOAC’s Therapy Dog program include the following: Increase empathy and compassion in children; help children connect to the center setting & reduce anxiety; improve social interaction/relationships and expand verbal and nonverbal communication.
Molly and Hazel are both mixed-breed rescue dogs who have undergone extensive training and are certified through The GO TEAM Therapy & Service Dog Organization. The Go Team is a registered 501(c)(3) non-profit organization, which is also recognized as a certified therapy dog organization through the American Kennel Club (AKC).
Both Molly and Hazel have also obtained their CGC (Canine Good Citizen), CGCU (Canine Good Citizen Urban), and CGCA (Advanced Canine Good Citizen) Certifications through the AKC. Both dogs are brushed daily groomed every other week, whichwill minimize any allergic contact. The Go Team also requires regular veterinarian checks for registered Therapy Dogs, along withregular evaluations to maintain certification.
Please complete the form below acknowledging your preference as to whether you wish your child to have contact with NOAC Therapy Dogs, Hazel and Molly.
Name: ______
☐Yes, my child may have incidental or child-initiated contact with NOAC Therapy Dogs during
the time my child receives services at NOAC
☐No, my child may NOT have contact with NOAC Therapy Dogs
Explanation______
Parent Signature & Date______
If I should change my mind regarding my child’s interaction with NOAC Therapy Dog, I understand that I must provide this in writing to Clinical Director.