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OWNER'S NAME

ADDRESS

CITY

STATE

ZIP

HOME PHONE

WORK PHONE

CELL PHONE

FAX

EMAIL ADDRESS

EMERGENCY CONTACT

CONTACT'S PHONE

DOG'S NAME

DATE OF BIRTH

OWNED SINCE

BREED

DOG'S BACKGROUND?

VETERINARIAN

VET'S PHONE

IS DOG IN GOOD HEALTH?

IF NO,
EXPLAIN

IS DOG ON ANY
MEDICATIONS?

IF YES,
EXPLAIN

DOES DOG PLAY OFF-LEASH WITH OTHER DOGS?

FREQUENCY
OF PLAY?

HOW DOES
DOG PLAY?

IS DOG AFRAID OF ANYTHING OR ANYONE?

IF YES,
EXPLAIN

WHAT DOES DOG DO?

HAS DOG
GROWLED AT
ANYONE?

IF YES,
EXPLAIN

HAS DOG
EVER BITTEN?

IF YES,
EXPLAIN

ANY FORMAL TRAINING?

TRAINER
OR SCHOOL

LEVEL OF
TRAINING

DOG KNOWS

	SIT		DOWN		STAY
	LEAVE IT		COME		HEEL

HOW DOES DOG GREET PEOPLE?

REFERRED TO
BANDILANE BY

PLEASE REGISTER MY DOG FOR THE CLASSES BELOW:
Please see Agility Classes - Pet Training - Rally & Competition Obedience
and TTOUCH Workshops for descriptions

2008 TUITION
$210 for All 7-Week Classes
$190 for All 6-Week Classes
$15 per Class for Show Handling Classes

Please make check payable to BANDILANE SCHOOL FOR DOGS, INC.
or we can take your credit card over the phone 203-975-8151.
Sorry, but we do not take American Express.

Space is Limited!
Payment, in full, must be received
to reserve your spot in class.

REFUND POLICY:
Prior to start date, FULL REFUND
Between Week 1 and Week 2, 50% REFUND
After Week 2, NO REFUND

WRITTEN PROOF OF VACCINATIONS IS REQUIRED
You may fax copies to us at 203-975-7457

Distemper and Parvovirus, Rabies* -- Titers Accepted
*Rabies not required for Puppy Class

Bordetella (Kennel Cough) also required for Daycare

__________________________________________________________________________________________________________________

BY APPOINTMENT ONLY - PLEASE REGISTER MY DOG FOR:

DAYCARE

PRIVATE LESSONS

PROFESSIONAL GROOMING

__________________________________________________________________________________________________________________

COMMENTS:

__________________________________________________________________________________________________________________
I will not hold Bandilane School for Dogs, Inc., 80 Largo Drive, Stamford, CT, Joyce Diamond,
any trainer teaching at Bandilane School for Dogs, Inc., any employee, groomer, or anyone
associated with them responsible for injury to persons or property caused by my dog or any dog
brought by me. Nor will I hold them responsible for physical harm which might come to me or my dog
while on the premises of Bandilane School for Dogs, Inc. or off premises in a group or private lesson.

I agree to the terms above.