Please enable JavaScript in your browser to complete this form. - Step 1 of 5Thank 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. NextHandler's InformationName: *FirstMiddleLastAddress: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone: *Email: *Will you be renewing an additional handler? *YesNoAdditional Handler InformationName: *FirstMiddleLastAddress: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone: *Email: *PreviousNextDog's InformationDog's Name: *Age: *Please provide your dog's most recent vet records - including the date of their vaccinations. * Click or drag a file to this area to upload. Please attach the Animal Health Assessment form that has been completed by your veterinarian. * Click or drag a file to this area to upload. Will you be renewing an additional dog? *YesNoAdditional Dog InformationDog's Name: *Age: *Please provide your dog's most recent vet records - including the date of their vaccinations. * Click or drag a file to this area to upload. Please attach the Animal Health Assessment form that has been completed by your veterinarian. * Click or drag a file to this area to upload. PreviousNextHandler 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? *YesNoDoes your dog have any history of biting humans as an adult dog? *YesNoPlease 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? *YesNoPlease explain: Is there a specific population or age group that your dog is aggressive towards? *YesNoPlease explain: Are there any animals that your dog is reactive towards? *YesNoPlease explain:Does your dog have any known health concerns? *PreviousNextRegistration and PaymentI will be renewing my therapy certification in: *WilmingtonRaleighCanines for Therapy - Wilmington *Team Renewal - $ 100.00Additional Handler - $ 25.00Additional Dog - $ 25.00Canines for Therapy - Raleigh *Team Renewal - $ 10.00Additional Handler - $ 25.00Additional Dog - $ 25.00Submit Share this:FacebookX