Class Day__________Time__________

Name of Owner____________________________________________________________ Date ____________________

Address____________________________________ City____________________ State__________ Zip __________

E-mail Address ____________________ Phone_______________ Occupation ______________________________

Name of Person who will train dog_________________________________________________________________

Dog's Call Name_________________________Breed____________________ Age__________ Sex__________

Did You attend Heartland's Beginner, Intermediate or Novice Class?__________________________________
When?________________________________________________

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

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

Are you planning to show your dog in Rally, Obedience or Agility?____________________________

Have you registered with the AKC, or the UKC or do you need forms?____________________________

How Did You Learn About Heartland? Newspaper __________ Phone Book __________ Online__________
Friend________________Pet Shop_______________Veterinarian_________________________
Groomer_____________________________________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, myself or minor children.
Signature of Dog's Owner
*If owner is a Minor, Responsible Adult Must Sign___________________________________________

Mail to:    Heartland Dog Training - 1202 E. Fairoaks -- Peoria, Illinois 61603
Fee must be sent with the application to guarantee a place in the class.

Fee Collected By________________________

Copyright^©2008 Heartland Dog Training Center