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Launch Membership Application

Member Application

Membership Application to be completed by those interested in becoming members of BIDT.

Name of Handler (Primary)
Age
Name of Handler 2
Age of Handler 2
Name of Handler 3
Age of Handler 3
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Work Phone
Email
Name of Dog
Sex Of Dog
- Male
- Female
Spayed or neutered?
- Yes
- No
Breed (i.e. Poodle, Sheltie, Mixed)
Date of Birth
MM slash DD slash YYYY
Weight
Has you dog had regular vet visits and current on all shots?
- Yes
- No
Has you dog showed any aggressive behavior toward people?
- Yes
- No
Has you dog showed any aggressive behavior toward other dogs?
- Yes
- No
Does your dog have its AKC Canine Good Citizen certification? (if so, please submit a copy when applying)
- Yes
- No
How did you hear about Believe in DOG Therapy?
Upload your AKC CGC Certificate Here.
Max. file size: 100 MB.
Upload your AKC CGC Certificate(s) Here if you have more than one dog in the program.
Drop files here or

Max. file size: 100 MB.
Upload Vet Record
Max. file size: 100 MB.
Upload Vet Record(s) here if you have more than one Dog in the program.
Drop files here or

Max. file size: 100 MB.
Upload Rabies Certificate
Max. file size: 100 MB.
Upload Rabies Certificate(s) here if you have more than one Dog in the Program.
Drop files here or

Max. file size: 100 MB.
Consent
I hereby certify that I have read and understand the Rules / Guidelines of Believe in DOG Therapy and to the best of my knowledge. I understand that secondary liability insurance coverage will be supplied by Believe in DOG Therapy and my own homeowner's/renter’s policy will provide the primary coverage. I have answered truthfully all questions and agree to abide by said rules and guidelines; otherwise this registration will be invalid.
After you Submit this form a Payment Page will Display.

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