Course/Seminar Requested______________________Start Date_____________Time_________

Dog's Owner(s) Name _______________________________________________________

Dog's Name_______________________________________________________________

Address______________________________________________________________________

City / State /Zip:_________________________________________________________________

Phone: Day________________Evening_________________Email____________________

Occupation(s) _________________________________________________________________

Children: how many & ages_________________________Will any be attending w/you?_______

Do you, or anyone attending with you, have any special needs we should be aware of? Please be specific________________________________________________________________________
______________________________________________________________________________

Breed of Dog__________________  Dog's Age____   Dog's Birthday___________

Sex (please check one): Neutered Male___  Spayed Female___  Intact Male___  Intact Female___

How old was (s)he when you got him?_________ Name & Location of Breeder/shelter/store/etc:
______________________________________________________________________________

Veterinary Hospital/Clinic_________________  Name of Vet you see most often______________

Problems you would like to work on with your dog: _____________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Is this your first dog?_____Have you trained before?___When/where?______________________

Vaccine Information: Shots required to participate in any class or workshop include Distemper, Parvo, Rabies, and Canine Cough.
Puppies must have started their vaccinations according to your veterinarian's recommendation. It is fine to start Puppy Kindergarten etc so long as you bring in their shot record as it's updated. Adult Dogs should be current on all shots.
A photocopy, which we keep on file, of proof of vaccinations must be supplied with your registration to be accepted...by the first night of class at the latest. The receipt from your veterinarian may serve to indicate what shots you dog is current on, others practices provide a letter or form such as is used for kenneling.

Date of Last inoculation: Distemper/Parvovirus_______ Canine Cough________ Rabies_______

Name of Owner(s) as you'd like to appear on diploma_________________________________

How did you hear of Canine University? Please check all that apply:
Former or current trainee (Name of dog and/or owner) ____________________________ Vet_____  Breeder_____  Groomer_____  Pet Sitter_____  Pet Shop_____  Phone Book_____  Newspaper_____  WWW_____  CU's Website_____  Other_____
Please specify name(s)*____________________________________________________________
*people, dogs; DVM, business name; specific website URL or newsgroup; white or yellow pages, etc...Thank You!!!

Notes:

• No dogs the first night of class for Puppy Kindergarten & Adult Beginners, or to your first Beginner Obedience Module. All others please bring your dog to all classes unless otherwise specified
• Classes are filled as registrations and tuition payments are received. Full tuition is due with this application to reserve a space, but no later than the first night of class. We accept cash, credit/debit cards, and checks as payment; make checks payable to Canine University. Returned checks will incur an additional charge of $20 per instance.
• Please review directions & note class dates; if you have any questions call us at least 48 hours in advance for assistance.
• Parking is ample after 6PM on weekday evenings and weekends, both in front of our training center (and on your way into the industrial park should those spaces be full); please do not block garage doors, any doorways or other cars in.
• Anyone who lives with the dog and is interested in training him/her is encouraged to attend and participate in classes. Children who are not directly training the dog should be supervised by an adult (other than the person training the dog) during instruction and exercises
• You should walk your dog prior to entering our training center. There is a small exercise area on the right between our building & Atlas Auto, as well as a grassy area on the left as you enter the industrial park from Winter St. Please be responsible and clean up after your pet, and do not allow them to mark or soil any common areas, doorways, etc.
• For optimum results,we recommend you practice with your dog at least 10 minutes/day.
• For 6-week obedience classes- If you are going to miss a class, you may request the homework up to one week prior and you can make up that class within six months. Don't forget that the first night is mandatory for all beginner classes.
  For 4-week module classes- due to the flexibility and frequency, makeups are not available once your course and/or four week interval has concluded.

Cancellation policy: Full refund if you notify us 48 hours prior to class start date. Makeup classes only- for the person or dog originally enrolled- thereafter; this is non-transferable and must be used within 6 months of the start date for the class originally enrolled in. For modules and building blocks, makeups are not available once your four week interval has concluded. Lack of attendance does not constitute course withdrawl. If a course is cancelled by Canine University, you will be allowed to enroll in another class or provided a refund.

As a condition to acceptance of this registration, the following agreement must be signed:

As legal owner of my dog, I hereby waive and release Canine University, its owners, employees and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of any such damage or injury while attending any training session, function or activity or while on the grounds or the surrounding area thereto.

In consideration of and as inducement to the acceptance of my application for training by Canine University, I hereby to agree to indemnify and hold harmless Canine University and its owners, employees and agents from any and all claims, or claims by any member of my family or any other person accompanying me to any training session, function or activity of Canine University or while on the grounds or the surrounding area there to as a result of any action by any dog, including my own.

Owner____________________________________________________ Date_________________

If paying by credit or debit card, please print out and attach the confirmation email. Note that electronic payments are processed via Paypal and that Canine University does not store or see your account information.

Please return this completed application with Full Payment and Proof of Vaccinations to:

If you have questions, our phone number is (781) 324-3722, or email: training@CanineUniversity.com