Heartland Dog Training - Intermediate Sign-Up Form

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Intermediate Class

First Letter of
Student's Last
Name

Class Day__________Time__________

Name of Owner____________________________________________________________ Date ____________________

Address____________________________________ City____________________ State__________ Zip __________

E-mail Address ____________________ Phone_______________ Occupation ______________________________

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Name of Person who will train dog_________________________________________________________________

Dog's Call Name_________________________Breed____________________ Age__________ Sex__________

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Did You Attend Puppy Class?_______________________Where?________________________________________

Did You attend Heartland Beginner's Class?__________When?________________________________________

If the answer is No, where did you attend?____________________________________________________________

Are you planning to continue your dogs' training at the conclusion of the Intermediate Class?__________

How Did You Learn About Heartland? Newspaper __________ Phone Book __________ Online__________
Friend________________Which Pet Shop_______________Which Veterinarian_________________________
Which Groomer_____________________________________Other___________________________________

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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, myself or minor children.
Signature of Dog's Owner
*If owner is a Minor, Responsible Adult Must Sign___________________________________________

Mail to: Heartland Dog Training - 6818 North Galena Road -- Peoria, Illinois 61603
Fee must be sent with the application to guarantee a place in the class.

Fee Collected By________________________