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Pet Therapy Adult Volunteer Application

Thank you for your interest in volunteering as a pet therapy team at Middlesex Health.

Please complete all required fields below to establish your applicant profile and apply for a volunteer position.

Applications are reviewed by our Volunteer Coordinator in a timely manner.

Application Information

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Emergency Contact Information

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Education Information

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Current/Most Recent Employer Information

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Pet Therapy Information

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Canine Information

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Volunteer Experience

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Daily Availability 

Please tell us when you are available. (Check all that apply) 

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Applicant Statement

Please check the box below to acknowledge and agree with the following statements:

  • I understand incomplete applications will not be considered for processing.
  • I understand that documentation of proof of vaccination of measles, mumps and rubella (MMR) vaccine or laboratory evidence of immunity, proof of vaccination of 2 doses of the Varicella vaccine (vaccine for chicken pox) or laboratory evidence of immunity or history of chickenpox based on healthcare provider diagnosis, and a Tuberculosis Screening results via either a 2-step TB (PPD) skin test [If positive, chest X-ray is required], or Quantiferon Gold (preferred) will be required to volunteer with Middlesex Health.
  • I understand that a flu vaccine is required in season.
  • I understand that I will provide a copy of my canine's vet records and pet therapy certfication. 
  • I agree to abide by the policies and regulations of Middlesex Health and the Volunteer Services Department and to participate in orientation and training required by Middlesex Health.
  • I will hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients or personnel and not seek to obtain confidential information from a patient.
  • I understand that I may be dismissed from my duties if I fail to comply with hospital policies and procedures, willful wrongdoing or negligence and/or performing duties outside of my service guidelines, inappropriate behavior, or any other circumstances deemed contrary by the Director of Volunteer Services to the best interests of the hospital.
  • I authorize Middlesex Health to take my photograph in relation to my volunteer position.
Thank you for submitting your application. A confirmation message has been sent to your email.