Confidence Course Registration

To send in registration form please copy, paste, and fill out entire form in an email and email to info@caninecompanion.us OR print off this page, fill out, and mail to:

Canine Companion by Certified Trainers

11742 N. 825 W.

Huntington,IN46750

CANINE COMPANION

Confidence Course Registration Form- REGISTRATION FORM

COMPLETE & RETURN THIS PAGE

Date:                     __________________________________________

Owner’s Name:     __________________________________________

Address:                __________________________________________

__________________________________________

Phone (Home):      _______________________  (Work)____________

Phone (Cell):         _______________________

E-mail address:    __________________________________________

Dog’s name:         ____________________ D.O.B.     ____________

Breed/s:                 ____________________ Gender:  ____________

Regular Vet:                    ____________________ Phone #: ____________

Date of vaccinations:     ____________________________________

(if alternative measures have been taken, please explain)

When do you notice your dog being fearful?

  1. ______________________________________________________
  2. ______________________________________________________
  3. ______________________________________________________

Is there anything else you would like us to know about your dog?

________________________________________________________________________

________________________________________________________________________

_______________________________________________________________________

Where did you hear about our training program?

________________________________________________________________________