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E-Mail:
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Owner/Handler Name:
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Billing Address:
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City:
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State:
Zip:
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Work:
Cell:
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| Please complete the following information about
your dog: |
| Dog's Name: |
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Dog's Gender:
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Male |
Female |
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Dog's Age:
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Years |
Months |
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Dog Spayed/Neutered:
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Yes |
No |
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Dog's Breed (If mixed choose dominant breed):
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Dog Acquired From:
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Veterinarian:
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| Class Enrolled In |
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| Add Bonus Bag of Equipment? |
Yes |
No |
(Additional cost) |
Dog Trained in
Class Before? |
Where?
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What Class?
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| List Family Members Your Dog Lives With or Sees Regularly
(If children, list ages; also include other pets): |
1.
2.
3.
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4.
5.
6.
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| Your Training Experience: |
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| Dog's Personality : |
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Dog's Environment:
(choose as many as apply) |
Lives in house
Not allowed in house
Has fenced yard or run
Allowed to run free
Other dogs in family
Only dog in household
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| What are your goals for you and your dog? |
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| What do you like about your dog? |
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| What is not so good about your dog? |
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| How does your dog spend his/her day? |
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How did you learn of these classes:
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| Release: |
I register the dog named above and release Canines Unlimited,
Martha Fischbach, Shotokan Karate Club, other instructors and
any other associated entity from all liability for damages or
injuries of any nature that may arise in connection with training
classes. I certify this dog has had puppy vaccinations and is
immunized appropriately for health and safety, and is in healthy
condition, and is not a danger to other animals or humans. Canines
Unlimited has permission to use and retains all rights to use
any of my comments, photos, or audio/video materials made for
educational, informational, promotional or commercial purposes.
I understand there are no credits, transfers or refunds, and classes
are to be completed within the course time frame for which registered.
Classes may be added, combined, canceled or changed, subject to
enrollment. Due to the flexible nature of class and enrollments,
I understand the importance of being on time to assure my place
in class, no reservations. Additional sections will be added if
classes are regularly over attended. I have read, understood and
agree with the class information, policies and fee structure and
agree to the payment schedule for which registered. (Please list
special problems or needs, or tax exempt number below).
Yes, I agree (must check box)
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List special problems or needs:
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