MO-KAN PET PARTNERS TEAM EVALUATION
Veterinary Specialty and Emergency Center, 11950 West 110 th Street, Overland Park, KS 66210
Sponsored by: Mo-Kan Pet Partners Association
COST: $20.00 per animal
Mo-Kan Pet Partner Members recertifying $10.00
DIRECTIONS: The VSEC is one block west of Quivira on 110th Street. This is just south of I-435. There is a Quivira
exit from I-435. The Quivira exit is east of I-35 and west of Hwy. 69.
PURPOSE: The evaluation may only be performed for the purpose of evaluating teams for Pet Partners, and
may not be performed in conjunction with evaluations for other therapy animal organizations, the AKC
Canine Good Citizenship test, to certify an animal as a service animal, or for any other purpose (from Delta
Society’s Policies and Procedures Manual).
Appointments must be made. Call or e-mail, Joyce Maas PemCor@kc.rr.com , 816 942 6890 or info@mokanpetpartners.com. Appointments will be made in the order received.
SPACE IS LIMITED! YOUR CHECK WILL RESERVE YOUR SPOT.
Please include a copy of proof of current vaccinations, including rabies, with this form.
NO ANIMAL WILL BE CERTIFIED WITHOUT THIS PROOF!!!
Pets must be at least one year old. See attached information sheet about REQUIRED equipment.
(If you do not have an information sheet, please request one)
Please do NOT arrive more than 30 minutes before your scheduled time.
PER DELTA REGULATIONS, YOU WILL NOT BE EVALUATED IF YOU DO NOT BRING EVERYTHING ON THE
REQUIRED LIST ON THE FOLLOWING PAGE OR ARE LATE FOR YOUR SCHEDULED EVALUATION TIME!
ANIMALS MUST BE CLEAN AND GROOMED
REGISTRATION FORM
Please complete separate form for each animal.
NAME______________________________
PHONE____________________________________
E-MAIL_____________________________
ADDRESS___________________________
CITY/STATE/ZIP____________________________
ANIMAL NAME AND BREED_________________________________________________________
SPECIES____________________________
DATE OF BIRTH____________________________
I indemnify and hold Delta Society, Mo-Kan Pet Partners, and VSEC harmless from and against all claims, losses, liabilities, and damages to persons or property,
governmental charges of fines and attorneys fees arising out of the acts or omissions of Pet Partners® Animal Evaluation, including but not limited to interactions with
evaluators, volunteers, attendees, or animals, screening or demonstrations involving my pet, or transportation of my pet to or from the evaluation site or within the
evaluation site.
Are you registering for this evaluation in conjunction with another organization? Yes___ No___
If successful at the evaluation, do you agree to volunteer for Mo-Kan/Delta at least 4 times a year? Yes ___No___
DATE_____________________________
SIGNATURE_______________________________
PLEASE MAKE CHECKS (YOU MAY WRITE ONE CHECK IF YOU ARE TESTING MORE THAN ONE ANIMAL) TO:
MO-KAN PET PARTNERS ASSOCIATION. MAIL FORM WITH VACCINATION / RABIES RECORD TO: MO-KAN
PET PARTNERS, P.O. BOX 7496, OVERLAND PARK, KS 66207.
PLEASE SHARE THIS FORM WITH OTHERS WHO MAY BE INTERESTED.
We sincerely thank The Veterinary Specialty and Emergency Center for allowing us to hold our test at their facility.
Mo-Kan Pet Partners Information Sheet
We are pleased that you are interested in having your pet evaluated and certified. Our
organization is affiliated with the international Delta Society. You will find more information including
a description of the tests on the Delta Society web site ( www.deltasociety.org). Remember any
undesirable activity in the parking lot or outside the testing room by your pet or the handler will be
reported to the evaluator. Here are a few highlights that may affect your evaluation:
We value our volunteers’ time, and promise to do the same for you. Please respect the
volunteers and understand that a successful evaluation obligates you to volunteer for Delta and/or
Mo-Kan a minimum of four (4) times a year. If you are not ready to make this commitment, please
defer your evaluation until that is possible.
You are must either attend a workshop (contact Mo-Kan for information on upcoming
workshops) or complete the Pet Partners Team Training home study course from Delta Society prior
to the evaluation. You can obtain a book from the Delta Society website:
http://deltasociety.org/VolunteerAboutBecome.htm or contact Mo-Kan to purchase a book.
The website also lists in detail the steps required to become a Delta Society Pet Partner.
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All animals must wear a leather or fabric collar or harness and be attached to a leather or fabric
leash, no more than 6 feet in length both for the evaluation and for visits. Step #8 of the
Registration Packet (see Delta’s web site) has details of types of collars allowed. No metal links
are acceptable.
Required items to be provided by the Handler:
1. Completed Registration Packet, including completed Handler’s Questionnaire, the signed
Policies/Procedures form, and the completed Animal Health Screening Form from your
veterinarian. You may obtain the book and forms from the Delta Society website at
http://deltasociety.org/VolunteerAboutBecome.htm or contact Mo-Kan Pet Partners at
info@mo-kanpetpartners.com or PemCor@kc.rr.com , 816 942 6890.
2. The animal’s current rabies vaccination certificate. Rabies tags alone is not sufficient.
3. Towel or small blanket if the animal will be carried (cat or very small dog).
4. Acceptable collar or harness and leash.
5. The animal’s brush or comb.
6. Treat for one of the exercises.
7. If this is a renewal, bring the packet Delta sent to you, or print one from the Delta site,
www.deltasociety.org.
Please note that you and your animal are being evaluated as a team. This is a simulated visit;
please dress and conduct yourself accordingly. Treat the evaluation as if it were a visit to an
institution. DO talk to your pet and do what is necessary to make your pet and the people
conducting the evaluation comfortable.
Additional Expenses of Certification:
1. Delta Society fees for 2-year registration: different categories ranging from $20 to $75. This
covers the Delta newsletter and liability insurance. Members of Mo-Kan receive a reduced rate.
2. A photograph of you and your pet (Mo-Kan will take a Digital or Polaroid photo at no extra charge
at the site).
3. Any veterinarian’s fees for the animal health screening form.
4. Optional, but encouraged: Dues ($15 annually) to Mo-Kan Pet Partners. Dues are used for
newsletters, communication with the community (brochures), building our library for members’
use, use of the home study course, etc.
DO make a copy of what you send to Delta as packet suggests!