Fill out and send this form online. Or you can print and fax or mail it. Acceptance subject to availability and review of application. Payment due first night of class, cash or check only (a $20 service fee will be charged for bounced checks). If you do not receive a confirmation of receipt for this application by phone or email within 48 hours, please contact Marianne Roberson.

SESSION DATE (see class schedule):

Training Application for: (please check appropriate class)
	Class	Time	Fee
	Puppy	7:00-8:00 p.m.	$100.00
	Beginner-A	6:00-7:00 p.m.	$100.00
	Beginner-B	8:00-9:00 p.m.	$100.00

How did you hear about us?

Owner Name:

Owner Email:

Name of Person Training Dog:

Address:

City: State: Zip:

Phone:

Breed: Color: Sex:

Call Name: Birthdate:

HEALTH HISTORY:
Innoculations:	DHLPP	Date:
	Rabies	Date:
	Bordatella (required)	Date:
Lab Work:	Heartworm Test . . .	Date:	Pos.	Neg.
	Stool Check . . .	Date:	Pos.	Neg.

BEHAVIOR HISTORY:
Please check all appropriate boxes:
Housesoils	Chews	Digs	Mouths
Bites	Jumps Up	Barks Excessively	Aggressive

Other (explain):