Therapy Dog Handler Waiver And Liability Release Form

Therapy Dog Handler Waiver And Liability Release Form
Complete this form to provide handler and therapy dog details and acknowledge the waiver and liability release for therapy dog handler participation.
Handler Information
Full Legal Name
First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Therapy Dog Information
Therapy Dog Name
Breed
Age (years)
Registration / Certification Status
Other
Waiver and Release
Handler Signature
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Date Signed
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: