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Print and Fax registration to 389 - 2895

Name of Handler:

 _________________ City/Town: ____________________
Home Phone:

 _________________ Work Phone: ____________________
Email:

 _________________ Fax: ____________________
Dog's name:

 _________________ Breed(s): ____________________

Birth Date/pup age
in weeks:

 _________________ Sex: ____________________
Vet Clinic:

 _________________ Spayed/Neutered? ____________________
Vaccinations:

 1st __ 2nd __ 3rd __ Class interested in:

 _________________

Additional Comments/ Concerns/Behaviours:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________
Payment: Cash __ Visa __ MC __    
If by credit card:      
Name on card:

 ____________________    
Number:

 ____________________    
Expiration Date:

 ____________________    

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1132 Clyde Court (off Gardiners Rd & Cataraqui Woods Dr.)
Kingston, Phone (613) 389 - 2895 Email us

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