Basic Obedience Pre-Registration Form
Six (6) Week Program
Please mail this form to Keystone Dog Training by July 15, 2010.
Handler’s name: __________________________________ Date: _________________
Street address: _________________________ City: _____________ Zip code: ________
Home phone: __________________ Cell: _______________ Email: ________________
Dog’s name: _________________ Dog’s age: ______ Breed: _____________ M/F: ___
Spayed or Neutered: YES
NO
Dog’s origin: (circle one)
Shelter/Rescue
Professional Breeder
Amateur Breeder
Pet Store
Age of dog when acquired: _________
Farm
History of Aggression: Growling/snarling: YES NO
Bite: YES NO
If Yes Toward human: _____ toward another dog: _____
Please explain in detail:
_______________________________________________________________________
________________________________________________________________________
Describe your dog’s demeanor when with other dogs: ____________________________
INCENTIVE FOR SEEKING TRAINING AT THIS TIME:
_______________________________________________________________________
________________________________________________________________________
Previous training: Yes
No
If yes, location: _________________________________
I heard about Keystone Dog Training through:
Shelter
Veterinarian
A friend
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Internet
Newspaper
PROOF OF VACCINATIONS MUST BE PRESENTED IN THE FIRST CLASS
The minimum inoculations required are: DH(L)PP, Rabies, and
Bordetella (kennel cough)
Returning this completed form along with your enrollment fee will reserve a place in
class for you and your dog. Class size is limited and they fill quickly. Enrollment fee is
non-refundable. Please make sure of your commitment before you make your payment.
Mail this form and $130.00 (checks only) by July 15, 2010 to:
Keystone Dog Training
Mary Smallwood
1145 Bowers Bridge Road
Manchester, PA 17345
Please contact Mary Smallwood to let her know you plan to enroll in the
Basic Obedience class.
Email: [email protected]
Phone: (717) 268-1866
We look forward to working with you!
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