Membership Information Form

Please complete this form to help us provide you with more information about how you can join Paws 4 Healing.

Your Name
First
Your Email
Phone Number
What City and State do you live in?
City
State
Are you now, or have you ever been involved in Pet Therapy?
- Yes
- No
If Yes, what organization(s)?
If Yes, how long were you involved?
What breed of animal do you want to register with?
If other, what is the species?
If you want to register with a dog, what is the breed?
What sex is your dog?
Untitled
- Spayed
- Neutered
What is the age of your animal?
Why are you interested in volunteering with Paws 4 Healing?
Tell us why you feel your pet would be a good therapy animal.
Tell us about you and why you are interested in animal therapy.
Please click the submit button to send us your information.
Name
This field is for validation purposes and should be left unchanged.

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