Select Your Class & Class Start Date

Class Name:
Class Start Date:

Contact Information

First Name:
Last Name:
Email:
Phone:
Address:
City:
State:
Zipcode:

Dog's Information

Dog's Name:
Breed:
Current Age:
Color:
Dog's Sex:
Age Obtained:
Where did you get your dog?:

Previous Dog Experience

Hove you owned a dog before?
Yes No
If Yes, What Breed?
Hove you trained a dog before?
Yes No
If Yes, Where did you train the dog?

Short Question & Answer

State Briefly why you would like to attend this class.
What do you wish to accomplish?
How much time can you spend with your dog everyday?
Do you have a hearing impairment or physical disability?
What kind of food does your dog eat? (please list exact brand)

Vet Info

Vet Name:
Vet Phone:

Signature & Date

I understand I am training at Connecticut K-9 Education CEnter, Inc at my own risk and herby release Connecticut K-9 Education Center Inc from any and all liability for any personal injury and/or property damage caused by my dog or to my dog. I understand that dog training is not without risk and I assume full responsibility of any such injury or damage and the payment of any resulting liability. If there is more than one handler you must have all parties agree to these terms and sign this form.
Signature:
Must Agree to Terms*