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Participant's Last Name
Participant's First Name
Parent's Last Name (if participant is a child)
Parent's First Name (if participant is a child)
Participant's Date of Birth
Preferred appointment time (Approx 1 hour) beginning between 1:00 and 6:00 PM. Some appointments are also available on Saturday afternoons.
How did you find out about us?
Do you currently have a pet dog? (please answer yes ONLY if the person participating lives in the same household as the dog).
Please note that you do NOT necessarily need to have a dog to participate in our projects, but some of our projects are only for families that have dogs. This question allows us to determine which projects you or your child is eligible for.
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