First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number:
Name Of Dog:
Age Of Dog:
Breed Of Dog:
Is Your Dog Obdeience Trained?	Yes No
What Methods Were Used?
Email Address:
Additional Comments:
Cost for Therapy Dog certification is $150.00 and includes a minimum of 8 weeks of observation and instruction. All costs are due at time of registration and are nonrefundable. I agree to provide proof that my dog has been vaccinated against Distemper and Rabies disease. I agree to keep my dog leashed at all times during the class. I understand that I am responsible for the behavior of my dog at all times and release The Gift of Sunshine, Inc. and its representatives from any and all liability for any injuries caused/sustained by me and/or my dog. I further certify that the registered dog is not a hazard to persons or other dogs.
My typed name below shall have the same force and effect as my written signature. Signed: