A BETTER COMPANION PET TRAINING
Enrollment Form
Pet Parent Information
Pet Parent (Human) Name Others Attending Class
Select a State Kansas Missouri Street Address City State Zip Code
Telephone (Work) Telephone (Home) Telephone (Cell)
Will you accept text messages for Important E-Mail Address class information (cancellations)? Yes No
Pet Information
Select a Month January February March April May June July August September October November December Select a Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select a Year 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 Pet's Name Pet's Date of Birth
Select a Breed Affenpinscher Afghan Hound Airedale Akita Alaskan Klee Kai Alaskan Malamute American English Coonhound American Eskimo Dog American Pitbull Terrier American Staffordshire Terrier American Staffordshire Terrier Mix American Water Spaniel Anatolian Shepherd Dog Appenzeller Sennenhunde Argentine Dogo Australian Cattle Dog Australian Cattle Dog Mix Australian Shepherd Australian Shepherd - Minature Australian Shepherd Mix Australian Terrier Azawakh Barbet Basenji Basset Hound Beagle Beagle Mix Bearded Collie Beauceron Bedlington Terrier Belgian Laekenois Belgian Malinois Belgian Sheepdog Belgian Tervueren Bergamasco Berger Picard Bernese Mountain Dog Bichon Frise Black and Tan Coonhound Black and Tan Terrier Black Russian Terrier Bloodhound Bluetick Coonhound Boerboel Bolognese Border Collie Border Collie Mix Border Terrier Borzoi Boston Terrier Bouvier des Flandres Boxer Boxer Mix Boykin Spaniel Bracco Italiano Briard Brittany Brittany Mix Brussell Griffon Bulldog - American Bulldog - English Bulldog - French Bull Terrier Cairn Terrier Canaan Dog Cane Corso Catahoula Leopard Dog Caucasian Ovcharka Cavalier King Charles Spaniel Central Asian Shepherd Dog Chesapeake Bay Retriever Cesky Terrier Chihuahua Chinese Crested Chinook Chow Chow Chow Chow Mix Cirneco dell'Etna Clumber Spaniel Cockapoo Cocker Spaniel - American Cocker Spaniel - English Cocker Spaniel Mix Collie - Rough Collie - Smooth Collie Mix Corgi - Cardigan Corgi - Pembroke Corgi Mix Coton de Tulear Curly Coated Retriever Czechoslovakian Wolfdog Dachshund Dalmatian Dandie Dinmont Terrier Doberman Pinscher Dogue de Bordeaux English Setter English Toy Spaniel Entlebucher Mountain Dog Estrela Mountain Dog Field Spaniel Finnish Lapphund Finnish Spitz Flat Coated Retriever Foxhound - American Foxhound - English Fox Terrier - Smooth Fox Terrier - Toy Fox Terrier - Wire German Pinscher German Shepherd Dog German Shepherd Dog Mix German Shorthair Pointer German Shorthair Pointer Mix German Spitz German Wirehaired Pointer Glen of Imaal Terrier Goldendoodle Golden Retriever Golden Retriever Mix Gordon Setter Grand Basset Griffon Vendeen Great Dane Great Pyreneese Greater Swiss Mountain Dog Greyhound Harrier Havanese Ibizan Hound Icelandic Sheepdog Irish Red and White Setter Irish Setter Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Jack Russel Terrier Jack Russel Terrier Mix Japanese Chin Kai Ken Karelian Bear Dog Keeshound Kerry Blue Terrier Kishu Ken Komondor Kooikerhondje Kuvasz Labradoodle Labrador Retriever Labrador Retriever Mix Lagotto Romagnolo Lakeland Terrier Lancashire Heeler Leonberger Lhasa Apso Lhasa Apso Mix Lowchen Maltese Manchester Terrier Mastiff - Bull Mastiff - English Mastiff - French Mastiff - Neopolitan Mastiff - Tibetian Minature Pinscher Mountainview Cur Mudi Newfoundland Norfolk Terrier Norrbottenspets Norwegian Buhund Norwegian Elkhound Norwegian Lundehund Norwich Terrier Nova Scotia Duck Tolling Retriever Old English Sheepdog Otterhound Papillon Parson Russel Terrier Pekingese Petit Basset Griffon Vendeen Pharoah Hound Pitbull Terrier Pitbull Terrier Mix Plott Hound Pointer Pointer Mix Polish Lowland Sheepdog Pomeranian Poodle - Toy Poodle - Minature Poodle - Standard Poodle Mix Portguese Water Dog Pug Puli Pyrenean Shepherd Rat Terrier Redbone Coonhound Rhodesian Ridgeback Rottweiler Rottweiler Mix St. Bernard Saluki Samoyed Schipperke Schnauzer - Minature Schnauzer - Standard Schnauzer - Giant Schnauzer Mix Scottish Deerhound Scottish Terrier Sealyham Terrier Shar Pei Shar Pei Mix Shetland Sheepdog Shetland Sheepdog Mix Shiba Inu ShihPoo Shih Tzu Shih Tzu Mix Siberian Husky Siberian Husky Mix Silky Terrier Skye Terrier Soft Coated Wheaton Terrier Spinone Italiano Springer Spaniel - English Springer Spaniel - Welsh Staffordshire Bull Terrier Sussex Spaniel Swedish Vallhund Tibetan Spaniel Tibetan Terrier Vizsla Weimeraner Weimeraner Mix Welsh Terrier West Highland White Terrier Whippet Wirehaired Pointing Griffon Yorkshire Terrier Yorkshire Terrier Mix Pet's Breed Pet's Veterinarian Clinic
Is your pet in good health? Make a Selection Yes No
Is your pet current on vaccinations? Make a Selection Yes No The following are the vaccinations REQUIRED to attend classes: DHPP or DHPPC (Puppies must have at least two of the series of four) Bordetella (kennel cough) done within the last 6 months Rabies (if over 16 weeks - MUST be provided by a licensed vet) Fecal exam (actual stool sample examined) - done within last 6 months Has your pet been Heartworm tested? Make a Selection Yes No Heartworm tests are required for dogs over six months of age.
Has your pet been spayed or neutered? Make a Selection Yes No Not required for classes.
Has your pet had previous training? Make a Selection Yes No If so, please list:
Any health or behavioral issues? Make a Selection Yes No
Has your dog ever bitten a person or another dog? Make a Selection Yes No Does not eliminate the dog from classes (If your answer is "yes", please explain.)
Class Information
Select Class Enrolling In PuppyGarten DoggyGarten Basic Education Intermediate Learning Advanced Learning CGC Prep Course CGC Test Refresher Private - 1 Hour in Facility (with pet parent) Private - 1 Hour in Facility (without pet parent) Private - 1 Hour at pet parent home Rally-O Pet Therapy Session Tracking Ton 'O Tricks Petcetra Freestyle Dancing Continuing Freestyle Dance Agility Workshop Agility/Flyball Foundations Obstacles I Obstacles II Basic Agility I Basic Agility II Intermediate Agility Advanced/Continuing Agility Agility Practice Flyball Daycare Type of Class
Select Day of Week Monday Tuesday Wednesday Thursday Friday Saturday Sunday Select Month January February March April May June July August September October November December Select Start Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2009 Start Date of Class Select Time 12:00 12:30 1:00 1:30 2:00 2:30 3:00 3:30 4:00 4:30 5:00 5:30 6:00 6:30 7:00 7:30 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 AM or PM AM PM Time of Class
How did you hear about ABC's program? (If referred by a friend, please supply name.)
Release:
I understand and agree that ABC Pet Training shall not be liable for any injury or damage to any person, pet or property, which results from the training or behavior or my pet. I further agree that ABC and its employees shall not be held liable for any costs or expenses incurred in connection with any claim occurring as a result of my pet's participation in the program. I also agree that ABC will not be held liable for any injury caused to my person, property or pet while attending a training class as a result of my own negligence.
Make a Selection I Agree to the Release Policy I Disagree to the Release Policy
Refund and Transfer Policy:
NO REFUNDS WILL BE ISSUED, unless the class has been cancelled by ABC and no other option is available to the pet parent. If you have attended any of the class sessions a partial refund will be credited at the rate of $13.50 per class attended of an 8-week session and $18.50 per class attended of a 6-week class. NO REFUNDS WILL BE GIVEN AFTER WEEK 4 OF AN 8-WEEK COURSE OR WEEK 3 OF A 6-WEEK COURSE.
In addition, if a pet parent requests a transfer to another class, for any reason, a $20 transfer fee will be assessed, along with a class payment as calculated above. For example, if you have attended 3 weeks of an 8-week manners class, ABC will apply $40.50 toward the tuition of the new class. This results in a balance due by the pet parent of $89.50 to transfer to a different class ($69.50 class credit, plus $20 transfer fee). Please note that credits will only be valid for 180 days from the purchase date. After that time, all credits will be forfeited to ABC Pet Training. In addition, credits may only be applied once. If the second class is not completed, all credits will be forfeited to ABC Pet Training.
Make a Selection I Agree to the Refund & Transfer Policy I Disagree with the Refund & Transfer Policy
You must hit the SUBMIT button or your form will not be forwarded to us. In addition, there is as occasional glitch in the system so if you have not received a confirmation e-mail within 48 hours, please call us at (816) 863-7639 to ensure enrollment in your class.