STUDENT INFORMATION FORM

After you have successfully Registered for your desired course, we ask that you complete this basic information form for our records. Thank you, and we look forward to working with you and your dog!

Your Full Name

Your Birthday

How Did You First Hear About Our Dog Classes?

Street Address

City

State

Zip

Phone

Alt Phone

Dog's Name

Breed

Dog's Age: Months or Years

Sex: Male or Female

Spay/Neuter: Yes or No

Shelter/Rescue/Breeder's Name & Location

Describe your dog's current behavior problems.

Vet's Name

Vet's Location

Vet's Phone

By checking this box and signing below, I certify that I am the legal owner of the dog indicated above. I do hereby waive and release Marianne Frederick (TRAINER) from any and all liabilities of any nature. I agree to take complete responsibility for the actions of my dog and myself, before, after and during class. At no time will the instructor of this class or the property owner, be liable or responsible for the actions of myself, my dog or any other person who accompanies me to class.

Signature

Date

Thanks for filling out this Information Form for our class. We can't wait to meet

You & your Fur Kid!