Animal Chaplain Services
Supporting Pets and their Human Companions
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Application

ANIMAL CLERGY COURSE APPLICATION

Fill out the application, below, and send with your donation to The Helping Paws Fund (made out to karen j cohen) to:
                                                                  Chaplain Karen j Cohen
                                                                  230 Pebble Hill Way
                                                                  Rockledge, FL 32955

NOTE: Your donation helps to cover the cost of processing your application, reviewing the completed requirements,
           your certificate upon completion and to help animals in need. Donation is a minimum of $95.00.

IMPORTANT: Your donation is non-refundable.
So if you are not accepted into the course or you don't pass the
                      course or you drop out of the course your donation is still non-refundable. Therefore, please read all
                      the requirements and make sure you can fulfill them before sending in your application. See all
                      requirements under the "Certification Training" tab.

                                                                 APPLICATION

Name:                                                                                                        Date:
Professional Title/Name:
Ordination Denomination:
Ordained by (include address):


Ordination Date:
Certificate of Ordination/Title attached to application [  ] Yes
Your Address:



Area of Residence (county, nearest major city):
Locations you hope to serve:


Affiliated with which spiritual denomination or religious entity and in what capacity (e.g., The New Seminary,
Theological Seminary, etc.)?

Professional Memberships: (may attach separate page and/or resume)

Education: (may attach separate page and/or resume)

Professional Background/Summary of Employment History: (may attach separate page and/or resume)

Have you ever been convicted of a felony? [  ] Yes      [  ] No
If yes, please describe and give date(s):


List two (2) non-family references who can speak to your personal relationship with animals and children:




Please complete the following:
1.     I believe . . .
2.     Why would you like to start an Animal Ministry?
3.     What kind of Animal Ministry do you intend to offer?
4.     Please describe the services you intend to provide?
5.     Would you charge a fee? If so, how would you decide on the fee(s) to be charged?
6.     How will you respond to the question we get most often which is, "Do animals go to heaven?"
7.     What will you do if your client/customer/parishioner disagrees with you theologically to the question #6, above?
        How would you handle it?

Your telephone and/or cell phone contact information:

Your e-mail:

Do you have a website?  [  ] Yes     [  ] No
If yes, please list it here:

Additional information you would like us to know:



Please read and sign the Pledge below:
I pledge to respect and honor all people regardless of race, religion, national origin, faith practices, personal beliefs,
sexual orientation,and any other aspects.
[  ] Yes     [  ] No

I am willing to provide personal and/or professional references upon request.
[  ] Yes     [  ] No

I promise that the information provided is true and correct to the best of my knowledge.
[  ] Yes     [  ] No

I agree to enter into this covenant of professionals, and will uphold the highest standards of integrity, honor and
professionalism. I am joining as a member of this esteemed organization in the spirit of brotherhood/sisterhood,
upholding peace and tolerance for all, and with a commitment to interfaith respect. My personal profile information is forthright and honest. I promise to always serve the spiritual needs of children in the presence of other adults, AT ALL TIMES.
[  ] Yes     [  ] No

I am not joining in order to proselytize my own personal beliefs, but to honor the individual beliefs and spirituality of others. If any of the beliefs and requests of my clients interferes with my own personal standards, I will politely decline their business and refer them back to Companion Animal Clergy/Interfaith Officiants,so that they may choose another Officiant who can help them.
[  ] Yes     [  ] No

Signature and Date:

Check-list: Have I enclosed:
[  ]  Thorough and accurate contact information?
[  ]  Completed Application?
[  ]  Copy of Certificate of Ordination?
[  ]  Donation to The Helping Paws Fund (made out to Karen j Cohen)?

For further information about Chaplain Karen j Cohen and her Animal Chaplaincy, please go to: www.animalchaplain.info

To e-mail her:
chaplainkarenjcohen@gmail.com


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