Contact Information Form
For use by Barker Canine Academy only
Email address *
First and Last Name
Your answer
Address
Your answer
Phone Number
Your answer
Best way to contact you (Mark all that apply)
When is the best time to contact you?
What times are you available for training?
Your answer
What areas are you interested in improving with your dog? Please mark all that apply.
Pet's Name
Your answer
Pet's Age
Your answer
Pet's Breed
Your answer
My pet is:
Does your pet have any food allergies? If yes, please state what they are allergic to. *
Your answer
Date of Rabies Vaccine.
MM
/
DD
/
YYYY
Is the Rabies vaccine a 1 year or 3 year vaccine? *
Date of Dhpp Vaccine.
MM
/
DD
/
YYYY
Is the Dhpp vaccine a 1 year or 3 year vaccine?
Do you give me permission to contact your Veterinary Clinic to verify vaccines? If you do not know the dates of vaccines this will give permission to get that from your Veterinarian. *
If yes, What is the name of your Veterinary Clinic and their phone numer?
Your answer
How did you hear about Barker Canine Academy?
Your answer
Would you allow us to use pictures/videos of your pet on our website and social network sites? *
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