*Name of Handler:

City / Town:

*Home Phone:

Work Phone:

*Email:

Fax:

Dog's Name:

Breed(s):

Birth Date/
Pup age in weeks:

Sex:

Male Female

Vet Clinic:

Spayed/Neutered:

Yes No

Vaccinations:

1st 2nd 3rd

Class:

Puppy K Puppy Grad Beginners Advanced Show Handling Open Novice Agility Flyball

How did you hear about us?

Newspaper Phonebook Magazine Word of Mouth Online

Comments:

- Behaviour Concerns

- Shy/Fearful

- Aggression (People/Dogs)

- Other

  Payment by:

Visa

MC

Cash