Donate Here
Yes, I want to become an ITA Volunteer Therapy Team!
 
Please sign me up for the ITA volunteer training workshop for $95 on (see schedule for dates):
Date: City:
I want a team evaluation with my animal (first screening is $30; second screening is $25; additional screenings are $20 each). Call to request a specific time preference between 9am and 2pm. Appointments are 30 minutes each. (see schedule for dates):
Date: City:
 
About Me:
First Name:
Last Name:
Email Address:
Street Address:
City:
State/Province:
Zip/Postal Code:
Telephone number:
About My Animal:
Name:
Species and breed:
Gender: Male  Female
Neutered? Yes  No
Age:
Where did you hear about this program?
Payment Information:
Total enclosed:
Payment method: credit card  check enclosed
Credit Card Type:
Credit card #:
Expiration date:  
Signature:
 

Print this page and mail to:
     Intermountain Therapy Animals
     P.O. Box 17201
     Salt Lake City, Utah 84117
or send send via facsimile to 801-272-3470.

Indemnity release—signature please!

I indemnify and hold Intermountain Therapy Animals harmless from and against all claims, losses, liabilities, and damage to persons or property, governmental charges of fines and attorneys' fees arising out of the acts or omissions of training workshops, including but not limited to interactions with instructors, attendees, or animals, demonstrations involving my pet, or transportation of my pet to or from the training site or within the training site.
Signature:
 
Date: