Ready to take your Therapy Dog Certification Test/Evaluation? Please fill out the form below. Name of Handler First Last Handler's Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Handler's Email Handler's PhoneAdditional Handler to be Tested(all handlers must be 14 or older and only one additional handler may be certified at the same time) Full Name (First, Last) Dog's Name(Please fill out a separate form for each individual dog being tested)Dog's Age(Dogs must be at least 1 year-old)Breed of DogWhere would you like to volunteer once you and your dog become a TDV-certified team?Dog's GenderMaleFemaleIs your dog currently on a raw meat diet of any kind?YesNo(therapy dogs must not be on a raw meat diet per TDV guidelines)If you do not know of a specific facility, what would you like to do with your certification?All certified teams are expected to become active volunteers with TDV (i.e., TDV does not certify dogs solely for community/school projects or short-term community service requirements.)Why you do want to become involved with Therapy Dogs of Vermont?First Choice for Test Location*WillistonManchesterSaint JohnsburyDerby LineUpper ValleySites will be determined at a later date. Please select the Vermont region that best applies to you.First Choice for Test Location*January 26, 2019 1:15 PMSites will be determined at a later date. Please select the Vermont region that best applies to you.First Choice for Test Location*October 27, 2018 1:30 PMDecember 1, 2018 10:30 AMSites will be determined at a later date. Please select the Vermont region that best applies to you.First Choice for Test Location*Sites will be determined at a later date. Please select the Vermont region that best applies to you.First Choice for Test Location*Sites will be determined at a later date. Please select the Vermont region that best applies to you.First Choice for Test Location*November 17, 2018 12:00 PMSites will be determined at a later date. Please select the Vermont region that best applies to you.View Testing DatesSecond Choice for Test LocationWillistonUpper ValleyManchesterDerby LineSaint JohnsburySecond Choice for Test Location*January 26, 2019 1:15 PMSites will be determined at a later date. Please select the Vermont region that best applies to you.Second Choice for Test Location*October 27, 2018 1:30 PMDecember 1, 2018 10:30 AMSites will be determined at a later date. Please select the Vermont region that best applies to you.Second Choice for Test Location*Sites will be determined at a later date. Please select the Vermont region that best applies to you.Second Choice for Test Location*November 17, 2018 12:00 PMSites will be determined at a later date. Please select the Vermont region that best applies to you.Second Choice for Test Location*Sites will be determined at a later date. Please select the Vermont region that best applies to you.View Testing DatesHow did you learn about Therapy Dogs of Vermont?Registration Fee Price: $45.00 Please proceed to PayPal to pay the registration fee using the button below. No PayPal account required. Your registration will not be valid until we have received payment. Thank you!EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
