Heartland Use Only

 Shots Ok
 Will Bring
 Need Collar

Owner's Name: _____________________________________________________________________

Street Address _____________________________________________________________________
City _____________________________________ State __________ Zip _____ Phone __________
Occupation ________________________________________________________________________

Complete If Trainer Is 12 to 16 Years of Age

Junior Handlers Age ____  Relationship to Owner ____________

If we find Junior Handler cannot handle the dog, or is not paying attention to instructions, we will ask an adult member of the family to take over. Children younger than 12 years of age are Not allowed in class or the training ring for everyone's safety.

Name of Handler (One Person): _____________________________________________________
Dog's Call Name: __________________________________ Breed:  ___________________________
Color: ____________________ Age: __________ Sex: ______ Birthdate: ____________________

Vaccination dates of .....
Rabies: ___________________ Distemper: ___________________ Parvo: ___________________

Did You attend Puppy Class?_____ Where? ____________________________________________

Is This Handler's First Obedience Training? ______________
If no, Where? ______________________________________

How Did You Learn About Heartland?
Newspaper          Phone Book         Friend        Pet Shop         Groomer          Veterinarian          
Other: ________________________________________________

I State that I am the owner of the dog named in this applicaion and that said dog is not a hazard or menace to other dogs or people. I further state that I am responsible for any injuries to people, dogs or damage to property caused by my dog, minor children or myself. By signing this Application, I understand and agree that the $80.00 class fee is non-refundable.

_________________________
Signature of Dog's Owner
*(If owner is 12 to 16 years of age, responsible adult must sign.)

______________________________
Signature of Dog's Handler
(If handler is 12 to 16 years of age, responsible adult must sign.)

Beginner's class Fee is $80.00.
Class Fees Are Non-Refundable.

Fee collected by:

____________________

Mail to: Heartland Dog Training, 6818 North Galena Road, Peoria, Il 61603

Non-Refundable Class Fee Must Be Sent With The Application To Guarantee A Place In Class.

Copyright^©2008 Heartland Dog Training Center

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