Family or group registration form - Animal

This form should be completed for all animals being included in the family or group annual membership. All info that is shared is is treated with complete confidentiality.

Q1 - Q3 require an answer, but if you do not have the info, please write "unknown". Q4 - Q8 are optional - feel free to include as much or as little info as you like.

Send the form by clicking the 'Done' button at the bottom of the page when you have finished, or if you prefer to send it via e-mail, just copy and paste the form (without clicking the "Done" button) into the body of an e-mail and send it to earthhealadmin[at]gmail[dot]com

Please send us a head and shoulders pic of the animal, with its eyes showing, to: earthhealadmin[at]gmail[dot]com

Thank you for registering the animal as a member of your group annual membership. We will soon be in touch with you via e-mail.

* 1. Animal's personal details:

* 2. Animal's usual residential location (nearest town/city, state, country):

* 3. Name of the person who arranged the family/group participation in this event:

* 4. The three main personal focuses for the animal during this event:

* 5. Please list any health issues the animal needs help with, surgeries they have had and medications being taken:

* 6. Important periods and dates in the animal's life - include traumatic or stressful times and events, accidents, injuries, deaths, births, miscarriages or abortions, loss of family, moving home etc.:

* 7. Please list any specific problems/challenges the animal is having that upcoming treatments should focus on:

* 8. If there is any other relevant info you would like to share with us about the animal, please do so in the box below: