Paws For Love
Pet Assisted Therapy
P.O. Box 20925
Reno, NV 89515-0925
(775) 826-5199
APPLICATION FOR MEMBERSHIP
Registration in a nationally recognized pet therapy organization, Therapy Dogs Incorporated or Delta Society, is required for membership in Paws for Love.
Please send the completed application (two pages) to the above address. You will be asked to pay a $10 initiation fee for your dog and $15 first year membership dues for a total of $25 to become an active member following successful completion of the admissions and registration process. Active members must have a registered therapy dog. Active members are entitled to one vote at membership meetings. Support members do not have any of the above requirements and are not entitled to vote. Junior members are under 18.
Type of Membership Personal Information Active Name (s) _____________________________ Support Address _____________________________ Junior City/State/Zip __________________________
(Check one) Phone (s) _____________________________
E-mail _____________________________
TDInc/Delta Society # ____________________ Renewal Date ________
Dog Information Name
Name _____________________ Name _________________________ Breed (best guess) ____________ Breed (best guess) ______________ Birth date (best guess) _________ Birth date (best guess) ___________ Male _________ Female ________ Male __________ Female __________
Member Statement
I certify that I have read and understand all documents contained in the New Member Application Packet. I agree to abide by all that is contained in those documents as well as any other guidelines adopted by Paws for Love when working my dog under the name of Paws for Love. I agree to abide by any additional guidelines established by a facility that I visit.
I understand that Paws for Love does NOT provide liability or any other form of insurance while participating in visits or other activities under the name Paws for Love. I agree to hold Paws for Love harmless for any incidents that may occur while participating in therapy visits or other activities under the name of Paws for Love.
Signature _____________ Print Name _______________ Date _________ Signature _____________ Print Name _______________ Date _________
Please enclose 2 letters of character reference to support your application.
Office Use Only: Check #: Date: ____ Amount: (Revised 01/02/08)
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Background Information
Please answer the following questions in order for us to learn a little about you, better understand your expectations of Paws for Love and learn what you may want to do as a member of the organization.
Where did you hear about Paws for Love?
Why are you interested in becoming a member of Paws for Love?
In which PFL activities are you interested? (Check all that are appropriate)
Visit Facilities Paws to Read Library Program Paws to Read School Program Parades Special Events Fund Raising
If you want to visit one ore more facilities with your dog (s), in which type of facilities are you most interested?
Are you interested in and/or willing to assume additional responsibilities in the leadership, administration, or operation of PFL as an organization? If yes, please provide us with your preferences as to what you might like to do and a brief description of the skills and talents you bring with you.
How much time are you able to commit to PFL and the services it offers?
Weekly: ________ hours or Monthly: ________ hours
What is your philosophy of being a volunteer service provider? Please use the remaining space to tell us anything else about yourself that you would like us to know and/or to ask any questions you may have.