Class Registration Form

OWNER INFORMATION

First Name:

Enter your Last Name please

Last Name:

Enter your Last Name please

Street Address:

Enter your street address such as 17778 24th Ave

Address Line 2:

Enter your extra street address info

City:

Enter your city you live in

Province:

Enter your Province or State you live in

Postal Code:

Enter your postal you live in

Primary Phone:

Please enter your Primary Phone number.

Secondary Phone:

Please enter another phone number we can contact you at.

Email Address:

Enter your email address we can contact you through.

Owner Name:

Owner Name for Graduation Certificate

DOG INFORMATION

Dog's Name:

Enter the name for your dog.

Breed:

What Breed is your dog?

Dog's Age

My Dog is ...

Please indicate if your dog is a male or female.

My Dog is spayed or neutered

Check if your dog is spayed or neutered

Date of Last Bordetella/Kennel Cough Vaccination

Please read the ? on the right hand side for more information

Date of Last Parvo/Distemper Vaccination

Read ? at right side for more information

SIGNING UP FOR CLASSES AT ..

Foundations Obedience in Langley at Harvey Pet Food (#15-20811 Fraser Hwy, Langley) Skill Builders Obedience in Langley at Harvey Pet Food (#15-20811 Fraser Hwy, Langley)

Start Date of Classes You are Enrolling In

More Information:

Anything else you'd like to add?

OTHER INFORMATION AND LEGAL NOTICES

POINT OR CLICK ON THE ? ON THE RIGHT SIDE OF THIS FORM TO READ EACH WAVIER.
ALL WAIVERS MUST BE ACCEPTED TO SUBMIT FORM.

I have read and understand the waiver above and agree to hold Canine Harmony free of any liability as a result of my participation

Read ? on Right side of page for waiver

Enter the code

ENTER THE BLACK LETTERS ONLY. CASE SENSITIVE

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