Name (of human volunteer) *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Have you and/or your pet ever been involved with another pet therapy organization where your membership has been terminated, suspended, or revoked? *

Yes

No

Have you signed up for an Etiquette Class online? *

Yes

No

Have you completed a Pet Behavior Screen Form online (if applicable)?

Yes

No

Not Applicable

You will receive a Furry Friends t-shirt (100% pre-shrunk cotton) after the processing of your application. Please tell us what size t-shirt you would like. *

Small

Medium

Large

X-Large

XX-Large