Instr Verified:    Shots Curr: ____     Fecal Curr: ____

PAW & HAND CLASS REGISTRATION

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: ____________________________________________________________

DOG’S CALL NAME:  ____________________  BREED: _____________________________

AGE: ________________      SEX: ___________________

Main Problem/Concern You Wish to Correct:______________________________________

____________________________________________________________________________

CLASS: ____________________________________________________________________

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.

Signature:   _______________________________________  Date: _____________

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