Pet Therapy Handler Form
Pet Therapy Handler Form
Handler Name:
Handler Name:
*
First
Last
Email
*
Number
Number
*
-
###
-
###
####
Type of animal:
*
Breed:
*
Name of animal:
*
Name of pet therapy organization:
*
Certification/Registration Date:
Certification/Registration Date:
*
/
MM
/
DD
YYYY
Is this a lifetime certification/registration?
*
Is this a lifetime certification/registration?
Yes
No
Certification/Registration Expiration Date:
Certification/Registration Expiration Date:
*
/
MM
/
DD
YYYY
Upload copy of pet therapy registration
*
Attach Files
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