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Therapy Dog Handler Application
Please complete this application if you will be a handler for a Facility Therapy Dog.
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Name
*
Your answer
Facility Name
*
Your answer
Handler Type
Primary
Secondary
Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Your answer
City, State, Zip
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
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