Canines for Therapy - Renewal Form

Thank you for renewing your Canines for Therapy certification!

This renewal form will require you to provide the following:

Updated information on both handler and dog
Your dogs most recent vet records
Animal Health Screening form completed by your veterinarian
Registration and payment information

Please note that you will not be able to submit this form without all of the above.

You can find a copy of the Animal Health Screening form by clicking here.

Handler's Information

Name: *

First

Middle

Last

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Phone: *

Email: *

Will you be renewing an additional handler? *

Additional Handler Information

Name: *

First

Middle

Last

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Phone: *

Email: *

Dog's Information

Dog's Name: *

Age: *

Please provide your dog's most recent vet records - including the date of their vaccinations. *

Click or drag files to this area to upload. You can upload up to 10 files.

Please attach the Animal Health Assessment form that has been completed by your veterinarian. *

Click or drag files to this area to upload. You can upload up to 10 files.

Will you be renewing an additional dog? *

Additional Dog Information

Dog's Name: *

Age: *

Please provide your dog's most recent vet records - including the date of their vaccinations. *

Click or drag files to this area to upload. You can upload up to 10 files.

Please attach the Animal Health Assessment form that has been completed by your veterinarian. *

Click or drag files to this area to upload. You can upload up to 10 files.

Handler Questionnaire

Answer these questions for each dog that you are registering.

Has your dog ever been encouraged to be aggressive,trained to bite, or trained in Schutzhund? *

Does your dog have any history of biting humans as an adult dog? *

Please explain:

List the commands that your dog has been trained on: *

Is there a specific population or age group that your dog is uncomfortable around? *

Please explain:

Is there a specific population or age group that your dog is aggressive towards? *

Please explain:

Are there any animals that your dog is reactive towards? *

Please explain:

Does your dog have any known health concerns? *

Background Check

A background check will be run using the information that has been supplied on this application or through your original therapy application. The background check fee is included in the cost of the renewal.

By checking the box below, I authorize Canines for Service, Inc. to obtain background information on me. I understand that any information obtained by Canines for Service, Inc. is confidential and will not be released to any person or outside agency without my written consent and will be used for the sole purpose of assessing volunteer eligibility.

I agree

Additional Handler Background Check

Is the additional handler that you are renewing over the age of 18? *

I agree

Registration and Payment

I will be renewing my therapy certification in: *

Canines for Therapy - Wilmington

Team Renewal - $ 125.00
Additional Handler - $ 50.00
Additional Dog - $ 25.00

Please select all that apply.

Canines for Therapy - Raleigh

Team Renewal - $ 35.00
Additional Handler - $ 45.00
Additional Dog - $ 25.00

Please select all that apply.

Canines for Therapy – Renewal Form

Thank you for renewing your Canines for Therapy certification!

This renewal form will require you to provide the following:

Please note that you will not be able to submit this form without all of the above.

Handler's Information

Additional Handler Information

Dog's Information

Additional Dog Information

Handler Questionnaire

*Answer these questions for each dog that you are registering.*

Background Check

Additional Handler Background Check

Registration and Payment

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Answer these questions for each dog that you are registering.