Membership Registration

Please have proof of disability and photos ready to upload of your dog, you and your dog, plus any certificates passed.

First name

Last name

Address

Email

Phone

Emergency Contact Phone Number

Name on Social media

Preferred method of contact Please note that current staff in the Association prefer not to use voice calls. If speech is your preferred method please use voice messages in messenger.

Dog Name

Dog Breed

Dog age

Photo of dog for ID Card

Disability to Mitigate (more than one can be selected)

Proof of Disability

This can be GP/Hospital letter, proof of disability benefits etc. Contact us if not sure. We require this as to have an Assistance dog you need to have a disability they can mitigate.

Tasks already trained

Tasks to be trained

Current obedience level

No certificates

Passed Puppy Class

Passed Kennel Club Bronze Canine Good Citizen

Passed Kennel Club Silver Canine Good Citizen

Passed Kennel Club Gold Canine Good Citizen

Other Training or Certification

Dates Assessments Passed

Puppy Foundation Certificate

If passed please upload a photo of your Certificate

Bronze Good Citizen Certificate

If passed please upload a photo of your Certificate

Silver Good Citizen Certificate

If passed please upload a photo of your Certificate

Gold Good citizen Certificate

If passed please upload a photo of your Certificate

Information about your team to be visible on website (wee blub about you and your dog)

Team Photo for Website

Emergency Contact Name and Relationship

Register your interest to be sent out the Member application and Dog Evaluation forms

Membership Registration