K9 Teams: Please order one card for each dog.

Membership Type:
Team LeaderCanine Team

Your Name:

Your Email:

Street Address:

Street Address Line 2:

City: State: Zip Code:

Date First Certified by HOPE:
(enter the month and year when you were first certified with this dog or as a team leader)

Dog's Information

Team leaders: Please enter N/A for these input fields.

Dog's Name:

Dog's Breed:

Dog's Date of Birth:

Dog's Stress Signs: (i.e. panting, tail tucked, avoidance)

Does your dog crate ok?:
YesNo

Human's Information

Your Stress Signs: (i.e. face flushes, sweat, or...?)

Special Information: (List any physical limitations, medic alerts, allergies, meds, etc. for you and your dog.)

Emergency Contact Name:

Emergency Contact Phone Number:

Please provide a portrait view photo of you and your dog, or just yourself if you are a team leader. Also, please wear your HOPE uniform shirt and have your dog wear their vest. Please attach your photo here.