2010 OTD Annual Renewal Form

Name:	Email:
Address:	Area of city:
City:	Province:	Postal Code :
Phone (res):	Phone (bus):	Fax:

Dog Form

ID Badge #	Dog Name	Date of Birth	Breed	Bandanna Size

INSTITUTION(S) YOU CURRENTLY VISIT:
(If additional space is required, please attach list.)

Name of Institution	Day, Time of Visits	Contact	Phone

Please remember that visits with your dog(s) are mandatory for your dog(s) to be considered a "Therapy Dog". Handlers of retired therapy dogs will be issued ID Badges on application to the Board and subject to fees for Associate
Members (members without therapy dogs).

Thank you for renewing and for your dedication to Therapy Dog work. You will be covered under OTD's Volunteer Ins urance programs while in service only as a volunteer with a current valid registration. (Our Insurance only applies within Canada.)

Please copy the Rules for Members for your records.

Membership Fees
Therapy Dog Team Membership (one handler, one dog) - $35.00
Associate Member (non–handler) - $15.00
Same handler – each additional dog $5.00

NOTE: Each handler must pay a separate registration fee. There are no family memberships.
Please include:

Your cheque or money order for the proper amount
- A Current Health Record Form (make sure that all shots are up-to-date, fecal test is current and
  negative)
- A signed “Rules for Ottawa Therapy Dog (OTD)” page (reverse)
- Your completed Handler Form (for Members

Yes, I have read and agree with the RULES FOR OTTAWA THERAPY DOG (OTD) MEMBERS and have mailed my cheque for to the address noted below. (Make cheques payable to Ottawa Therapy Dogs 2010.)

No, please explain.

Date:

Please send your payment to:

REGISTRAR
Ottawa Therapy Dogs
Suite 750, 1500 Bank Street
Ottawa, Ontario K1H 1B8

Should you have any questions, call 613.261.6834 (OTDI) or email us at info@ottawatherapydogs.ca.

2010 OTD Annual Renewal Form

Dog Form

INSTITUTION(S) YOU CURRENTLY VISIT: (If additional space is required, please attach list.)

INSTITUTION(S) YOU CURRENTLY VISIT:
(If additional space is required, please attach list.)