Instr Verified: Shots Curr: ____ Fecal Curr: ____
317 S. Market St, Muncy, PA 17756 (snail mail); 570-980-1546
Physical Location: 2164 Route 405 Hwy, Muncy, PA 17756
OWNER’S NAME: ____________________________________________________________
STREET/PO BOX/APT #: ______________________________________________________
CITY, STATE, ZIP: ____________________________________________________________
Primary Ph#: _______________________ Secondary Ph#: _________________________
EMAIL ADDRESS: ____________________________________________________________
Main Problem/Concern You Wish to Correct:______________________________________
Please check the schedule prior to completing this section
1st CHOICE DAY (Circle One) Mon Tues Thur
1st CHOICE TIME (Circle One) AM AFTN EVE
2nd CHOICE DAY & TIME (Circle Choices) Mon Tues Thur AM AFTN EVE
I attest that my dog has had the following vaccinations/tests on the dates indicated:
DISTEMPER/PARVO/PARAINFLUENZA: __/__/_____ Last fecal test __/__/_____
BORDATELLA: __/__/_____ RABIES (dogs under 12 wks exempt):__/__/______
Please bring vaccination & fecal records with you to orientation or to the 1st class.
PAYMENT: Make Checks Payable to: Paw & Hand Obedience AMT Pd: $___________
and mail to: Paw & Hand Obedience, 317 South Market St, Muncy, PA 17756
I understand that attendance at a dog obedience class is not without risk to myself, members of my family or guests who may attend, or to my dog. I hereby waive and release Paw & Hand, Lana Kline, John Kline, their agents, the instructors, and Mike Sullivan and his family & agents, from all liability or damages of any nature, including theft, resulting from actions of any dog or handler while on the training grounds, training room, house, buildings, or surrounding area. I also acknowledge that I have read the payment and pottying policies information printed below.
Potty your dogs to the west of the building, away from the building and parking BUT NOT ON THE NEIGHBOR’S LAND, Please. There will be poop bags and 2 “poop only” cans outside for your use. Do not let your dogs urinate anywhere close to the building. We do not want our gracious landlord to regret leasing to a dog-related business!
YOU MUST CLEAN UP AFTER YOUR DOG!!! No exceptions. Failure to follow this rule could result in you being expelled from classes and activities.
YOUR SPOT IN CLASS IS NOT GUARENTEED WITHOUT PAYMENT
NO REFUNDS FOR CLASS FEES UNDER ANY CIRCUMSTANCES