Therapy Dog Training Program Enrollment
Apply to join the Therapy Dog Training program at Grace & Integrity K9. Please provide your details and information about your dog.
Handler's Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Emergency Contact
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Dog Information
Dog's Name
*
Dog's Breed
*
Dog's Age (in years)
*
Sex of Dog
Male
Female
Other
Is your dog spayed/neutered?
Yes
No
Are your dog's vaccines current?
*
Yes
No
Upload Current Vaccine Records and Rabies Certificate
*
Upload Files
Drag and drop files here
Choose a file
Please upload current vaccine records and rabies certificate.
Cancel
of
Veterinarian Approval
Does your veterinarian clear your dog for Therapy Work?
Yes
No
Upload Veterinarian Approval Letter
*
Upload Approval Letter
Drag and drop files here
Choose a file
Please upload your veterinarian's approval letter (PDF or Word document).
Cancel
of
Has your dog had any previous training?
*
Yes
No
Previous Trainer Information
Trainer Name
First Name
Last Name
Training Facility
Trainer Contact Information
Please enter a valid phone number.
Format: (000) 000-0000.
Please describe your dog's temperament and any behavioral concerns.
Student Training Program Enrollment Statement
Prior Training Program Acknowledgment I acknowledge that I am voluntarily enrolling in a training program with Grace & Integrity K9. By signing below, I certify that: I have chosen to enroll with Grace & Integrity K9 of my own free will. Grace & Integrity K9 did not solicit, recruit, encourage, or persuade me to leave another service dog, therapy dog, or obedience training organization. My decision to participate in this program was made independently and without undue influence from Grace & Integrity K9 or its representatives. If I was previously enrolled in another training program, my decision to discontinue or transfer from that program was solely my own. I understand that Grace & Integrity K9 respects the work of other trainers and organizations and does not engage in recruiting or 'poaching' students from other programs. I further understand that providing false or misleading information on this acknowledgment may result in my enrollment being reviewed or terminated at the discretion of Grace & Integrity K9. I certify that the information provided above is true and accurate to the best of my knowledge.
Program Requirements
Please initial each item acknowledging your understanding.
I understand acceptance into the program is based on evaluation of both the handler and dog.
*
I understand the program is approximately 6 months.
*
Initials
I understand my dog must be healthy, well-groomed, and current on vaccinations.
*
I understand positive reinforcement training methods are required.
*
I agree to attend scheduled training sessions.
*
I understand certification is awarded only after successful completion of all program requirements.
*
I understand Grace & Integrity K9 reserves the right to dismiss any team demonstrating unsafe or inappropriate behavior.
*
I understand I am responsible for the purchase of all required gear.
*
Initials
I understand that additional training may be required from the facility I will be volunteering at
*
Initials
Payment Agreement
◯ Program Tuition: $1200
◯ Annual Renewal: $100
◯ Monthly Payment Option: 12 payments of $100
Liability Waiver
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that participation in dog training involves inherent risks. I voluntarily assume responsibility for myself and my dog while participating in any Grace & Integrity K9 training, evaluations, classes, or events. I agree to release, indemnify, and hold harmless Grace & Integrity K9, its directors, instructors, volunteers, and property owners from any claims, damages, injuries, or liabilities arising from participation, except where prohibited by law.
Applicant Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Application
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