Animal Assisted Therapy Application

Please complete this application to become an Animal Assisted Therapy Team at Johns Hopkins Medicine. Thank you!

New User Details

User ID

User ID (verify)

Password

Password (verify)

Application for New and Returning Teams

Animal Assisted Therapy

Please select the hospital where you would like to volunteer:

Personal Information

* First Name

* Last Name

Please only complete if you have an authorized JHED ID (e.g. jdoe173@jh.edu). Please leave blank if you DO NOT have an authorized JHED ID. 

* Date of Birth

* Home Address

* City

State

* Zip Code

* Phone (Mobile)

Phone (Home)

* E-mail address

Have you been an Animal Assisted Therapy team at Johns Hopkins in the past?

Emergency Contact

* Contact Name

* Relationship

* Phone Number

* Emergency Contact E-mail

Dog Information

Animal Assisted Therapy Certification Program

* Dog Name(s)

* Dog Breed(s)

* Dog Age(s)

Please upload the following documents for your pet therapy dog(s).

Animal Assisted Therapy Certifications

Dog Vaccination and Medical Records (must include Rabies vaccination and negative fecal test)

Photo of Dog(s)

COVID-19 Information

To continue to protect the health and safety of our patients, our workforce and the communities we serve, Johns Hopkins Medicine is mandating that all volunteers be fully vaccinated prior to coming on site. The CDC defines an individual as "fully vaccinated" when two weeks have passed since receiving the second shot of the Pfizer or Moderna vaccine, or two weeks after the single-dose Johnson & Johnson vaccine.

Have you received your COVID-19 Vaccine?

If applicable, please upload supporting documentation of your COVID-19 vaccination using the 'Choose File' button below. The documentation must meet the following criteria: Full name is present on vaccine documentation All dates of vaccine are legible All pages are present Documentation is readable If pharmacy receipt the vaccine must clearly be listed If the document is in a language other than English, it must include an English translation The vaccine indicated on the document is an acceptable vaccine per JH guidelines

Final Steps

* I certify all information is true and has been given voluntarily. I understand that this information may be disclosed to any party with legal and proper interest. I release the agency from any liability whatsoever for supplying such information.