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Heartland Dog Training Club Header

bowing puppyPUPPY
CLASS
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FIRST LETTER
OF STUDENTS
LAST NAME
DATE__________CLASS DAY--M_T_W_Th_F_S
CLASS TIME_______CONFIRMEDcheck boxCALL check box 		 
  1. Name of Puppy's Owner____________________________________________________________

    Street Address _______________________________e-mail address_____________________________
    City ________________________________________ State__________ Zip _______________
    Phone____________________ Occupation ________________________________________

  2. Print First Name of One Person Who will Train the Puppy.______________________________
    Puppy's call name______________________________Breed______________________________
    Color____________________ Age__________ Sex__________ Birthdate____________________

  3. Vaccination Record of Puppy....Dates Of..........
    Rabies____________________ Distemper____________________ Parvo____________________

  4. Has Handler Ever Given a Dog Obedience Training?____ Where______________________________________

  5. Fill Out If Trainer Is 12 to 16 Years of Age
    Age__________

    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.         		List problems you are having with your puppy
    ________________________________________
    ________________________________________
    ________________________________________
    ________________________________________

  6. How Did You Learn About Heartland?
    Newspaper check box Phone Book check box Friend check boxPet Shop check boxGroomer check box Veterinarian tiny check boxOthercheck box
    Do you mind listing them?______________________________

  7. 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
* NOTE: If owner is a Minor,
Responsible Adult Must Sign

____________________________________________________________ 		Puppy class Fee is $60.00.
Puppy Class Fees Are Not Refundable.
  Mail to:   Heartland Dog Training
1202 E Fairoaks -- Peoria, Il. 61603
 		Fee Collected By ______________________________

Fee must be sent with the application to guarantee a place in the class.

Copyright©2008 Heartland Dog Training Center