K-9 Healers - Enrollment Form

K-9 Healers

Obedience Class Enrollment

Print this form on your printer, fill out and send with your check to:

Gail Furst
2874 Tom Campbell Road
Branchport, NY 14418
(607) 522-7818
deepeace.rural@gmail.com

Please see agreement form which will be required prior to class beginning.

Please print when filling out the form. Please make checks payable to: K-9 Healers

Owner's Name: _____________________________________________________________________

Dog's Call Name:____________________________________________________________________

Dog's Age:___________ Breed:__________________________________ Sex:__________________

Address: __________________________________________________________________________

City:________________________________ State: __________Zip: _____________

Telephone: ___________________________________ Work: _______________________________

E-mail: ___________________________________________________________________________

Date of latest Vaccination/Titer for:

Rabies: ______________________ DHLPP _____________________

Have you trained a dog before? ________________________________________________________

How did you hear about this class? ____________________________________________________

__________________________________________________________________________________

What do you expect to learn in the class? _______________________________________________

__________________________________________________________________________________