Therapy Dog 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, IN 46750

CANINE COMPANION Agility III Form- REGISTRATION FORM

COMPLETE & RETURN THIS PAGE

Date of class:         __________________________________________

Location of class:   This class meets at a different location each week.

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 and with whom did your dog take his/her basic pet manners classes?

_____________________________________________________________________

_____________________________________________________________________

Goals you wish to accomplish with your dog in this class:

1.    ____________________________________________________________

2.    ____________________________________________________________

3.    ____________________________________________________________

4.    ____________________________________________________________

Is there any additional information you feel is important for us to know about your dog?

___________________________________________________________________________

___________________________________________________________________________