• Class Application

    Class Application

    Mid-Michigan Therapy Dogs, Inc
  • Season*
  • Preferred Class Time:*
  • Classes are filled in order of completed application and payment. We try our best to place you in your preferred class time. If that time slot is full, are you able to attend the other time slot?*
  • Your Birthday*
     / /
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • Dog's Birthday*
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  • Have you ever been convicted of a crime?*
  • Please provide details on your previous conviction.

  • Date
     / /
  • MMTD Handler’s Acknowledgment:

    When working with my dog in a therapy team capacity:

    • I will not be an active member of another therapy dog organization other than MMTD.
    • I will not be under the influence of drugs or alcohol.
    • I will not smoke or vape while on a visit.
    • I will not take money for visits. All donations go to MMTD.
    • I will not use a cell phone while on a visit.
    • I will dress in appropriate MMTD logo apparel & dog will be clean and in MMTD vest.
    • I will carry copies of our current insurance papers, shot records, license & certificate.
    • I understand and agree that I will not make any visits with my dog representing MMTD until certification is complete.
    • I understand that MMTD’s Liability Insurance is only in place in the following situations:
      • the therapy visit is done in a setting where the dog and handler are volunteering their time and efforts
      • total visit(s) is 3 hours or less per day
      • during the visit, the handler's primary “Task” is to be the handler of the dog therapy team, and not an employee/professional (therapist, teacher, social worker, etc).
  • Today’s Date*
     / /
  • Class Fee

    Current class fees are as follows: 1 Handler/1 Dog= $225, 2 Handlers/1 Dog= $350, current MMTD member with 1 new Dog= $160, 1 new Handler with a current MMTD Dog= $180 (If there is a second handler, the second handler must also fill out the Class Application).
  • Payment is required to review your application. We accept payments through Stripe or through mailed check. Please indicate how you would like to pay.*
  • prevnext( X )
            1 Handler / 1 Dog
            $225.00
              
            2 Handlers / 1 Dog
            $350.00
              
            Current MMTD Member / 1 New Dog
            $160.00
              
            1 New Handler / Current MMTD Dog
            $180.00
              
            Total
            $0.00

            Credit Card Details
          • Pay Later

            You have selected to pay later. Your application will not be reviewed until your check is received and processed. Thank you for your understanding.
          • Please make check payable to: Mid-Michigan Therapy Dogs, Inc.

            Mailing Address:
            Mid-Michigan Therapy Dogs, Inc.
            P.O. Box 320886
            Flint, MI 48532

          • I will be mailing a check with the following amount:*
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