Registration

First Name: Last Name: Address: City: Province: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Postal Code: - Zip Suffix Phone: Email: Age of Registrant Gender: Female Male Non-Binary Other Gender Pronoun Preference Pet's Name Breed Pet Date of Birth Sex of Pet Age of Pet at Registration Pet Weight in Pounds Dog Picture 1 Dog Picture 2 Type of Therapy Dog (Choose All that Apply) Therapy Dog Meaning 1/2 I understand what a Therapy Dog is. Companion Paws Canada pets are not Service Dogs or Guide Dogs. CPC pets are designated Therapy Animals. No Yes Therapy Dog Meaning 2/2 Yes No Aggression By clicking this checkbox, you confirm that your dog has never been agressive towards people or other animals and has never bitten a person or other animal. No Yes Spayed and Neutered Waiver 1/2 I understand that attendance at therapy dog activities is not without risk. I understand that attendance at therapy dog activities is not without risk to me, my family members, or guests who may attend, or to my dog, and that neither The LifeLine Canada Foundation or Companion Paws nor the owner/proprietor of any facility hosting events nor volunteers, trainers or adjudicators, assumes legal liability for my actions or the actions of my dog, other dogs, my family members or my guests in their participation in Companion Paws activities. I indemnify, agree to defend and hold harmless The LifeLine Canada Foundation and Companion Paws, the owner/proprietor of each facility hosting a Companion Paws event, volunteers, trainers and adjudicators and anyone acting on their behalf, from and against all claims losses liabilities, and damage to persons or property, governmental charges or fine omissions, including but not limited to participation in Companion Paws functions, training. workshops and evaluations. Mobile Yes No Waiver 2/2 Yes No Acknowledgement Timeline Notes or Comments Captcha