Registration form

PAWSitive Dog/Human Training

Make check out to Michelle Blount and mail to 14132 Blue Ridge Trail Windsor, VA 23487

Class: ð Puppy ð Basic ð Clicker 8 weeks $125 Start date:__________

Private: ð 6 lessons in home $500 6 lessons at my facility $300

Owner

Name: ____________ _________________

Address: _____________________________

_____________________________

Phone: _________________(Home) don’t call before___ After____

_________________(Work) don’t call before___ After____

_________________(Cell) don’t call before___ After____

EMAIL: _________________

Dog

Name: _____________________________

Breed: _____________________________

DOB: _____________________________

Spayed/Neutered (circle if applies)

Has your dog ever been aggressive to people or dogs? If yes, explain.____________________________________________

___________________________________________________

What are you specifically looking to work on in class?

___________________________________________________

___________________________________________________

How did you hear about our classes?____________________

ð Animal Medical Center of Chesapeake The Oaks Veterinary Clinic

ð Other______________________________

Or the instructor(Michelle Blount) liable for any injury that I or my pet may sustain from any other dog or my own dog, or any other property (not including willful or malicious conduct) through the participation in the obedience class.

I understand that there are some risks in this class situation where the temperament of the other dogs are unknown to me. I assume full responsibility for any injury to myself, my dog, or other property which may occur during the class. I understand it is my job to maintain control over my dog at all times.

I hereby certify that I am over 18 years old and have read and understood the above waiver.

I understand that with my signature I am holding a place in class and that I must cancel 7 days prior to lecture to receive a refund, no refund will be made after that time; however, at the discretion of the instructor, make up classes may be allowed.

Date:____________________ Signature:_________________________________


				Due to traveling for my husbands job,currently in Jax, FL for private lessons or doing seminars *Registration form*



	Home \| Links \| Michelles Bio and Training Philosophy \| Class/Private Lesson Details/Prices \| Client pictures and stories \| Upcoming seminar schedule \| Registration form






		PAWSitive Dog/Human Training Make check out to Michelle Blount and mail to 14132 Blue Ridge Trail Windsor, VA 23487 Class: ð Puppy ð Basic ð Clicker 8 weeks $125 Start date:__________ Private: ð 6 lessons in home $500 6 lessons at my facility $300 Owner Name: ____________ _________________ Address: _____________________________ _____________________________ Phone: _________________(Home) don’t call before___ After____ _________________(Work) don’t call before___ After____ _________________(Cell) don’t call before___ After____ EMAIL: _________________ Dog Name: _____________________________ Breed: _____________________________ DOB: _____________________________ Spayed/Neutered (circle if applies) Has your dog ever been aggressive to people or dogs? If yes, explain.____________________________________________ ___________________________________________________ What are you specifically looking to work on in class? ___________________________________________________ ___________________________________________________ How did you hear about our classes?____________________ ð Animal Medical Center of Chesapeake The Oaks Veterinary Clinic ð Other______________________________ Or the instructor(Michelle Blount) liable for any injury that I or my pet may sustain from any other dog or my own dog, or any other property (not including willful or malicious conduct) through the participation in the obedience class. I understand that there are some risks in this class situation where the temperament of the other dogs are unknown to me. I assume full responsibility for any injury to myself, my dog, or other property which may occur during the class. I understand it is my job to maintain control over my dog at all times. I hereby certify that I am over 18 years old and have read and understood the above waiver. I understand that with my signature I am holding a place in class and that I must cancel 7 days prior to lecture to receive a refund, no refund will be made after that time; however, at the discretion of the instructor, make up classes may be allowed. Date:____________________ Signature:_________________________________



		80% of class is training the Owner, 20% is training the dog