ONLINE CLASS or WORKSHOP REGISTRATION FORM
For Students who are paying ONLINE for their classes or workshops. PLEASE NOTE: YOUR SPOT IN CLASS IS NOT SECURED UNTIL WE ALSO RECEIVE YOUR PAYMENT.
HAVE YOU DISCUSSED CLASS OPTIONS WITH AN INSTRUCTOR FIRST? *
IF YOU ARE A NEW STUDENT, PLEASE DO NOT COMPLETE THIS ONLINE REGISTRATION REGISTRATION OR ONLINE PAYMENT WITHOUT SPEAKING to Lana Kline, training director, or one of the other instructors at Paw & Hand first. We want to be sure you are in the right class for you and your dog. Dogs with dog/human or dog/dog aggression are not good candidates for group classes. (We offer private lessons, too) If you have not already done so, please contact Lana at 570-772-1414 or pawandhand2012@gmail.com. Thank you!
Which Session Are you Signing Up For? *
Owner's Name *
Your answer
Street Address *
Your answer
Apt #/PO Box #
if applicable
Your answer
City, State, Zip *
Your answer
Main Phone # *
Your answer
Is Main Phone #
Secondary Phone #
Your answer
Is Secondary Phone #
Email Address *
Email is the preferred method of communication.
Your answer
Dog's Name *
(Call name; not registered name)
Your answer
Dog's Breed *
Your answer
Dog's Age *
please indicate years or months
Your answer
Dog's Sex
Please describe the main problem(s) or issue(s) you would like to resolve through training or have covered in class *
Your answer
Class or Classes to Register (If reg for Workshop, write it in next question) *
Please check all classes you are taking with this dog, this session. Not all classes are offered every session; please refer to the schedule on our website for what is currently offered.
Required
Name of Workshop, Seminar or Misc/Special Class
Please fill in if class you are taking is not in the above list, or, if you are taking a seminar
Your answer
First Preferred Day/Time *
Please check the schedule for the days/times your class(es) are being offered
Second Preferred Day/Time
Please check the schedule for the days/times your class(es) are being offered
I attest that my dog is up to date on the following shots: *
Please check the boxes next to the vaccinations for which your dog is current. Please add the date below.
Required
Date of Vaccinations *
Please indicate the date the majority of the vaccinations were given. Month and year are sufficient
Your answer
Date Rabies Vaccination was given *
Please indicate month and year of current rabies vaccination
Your answer
Amount Paid Online via SQUARE Point of Sale
Please write in below the amount you paid online for your class or workshop or seminar. If taking a class, please speak to us if you haven't already, so we can make sure you are in a suitable class. Workshop registrants do not need to call first.
Your answer
Signature & Waiver *
BY TYPING MY NAME BELOW, I AM PROVIDING MY ELECTRONIC SIGNATURE, ATTESTING THAT: 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 Obedience, 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.
Your answer
Other Info *
Potty your dogs at the west side of the building. YOU MUST CLEAN UP AFTER YOUR DOG!!! Poop bags and special poop cans are provided for you. YOUR SPOT IN CLASS IS NOT GUARANTEED WITHOUT PAYMENT **NO REFUNDS FOR CLASS FEES UNDER ANY CIRCUMSTANCES** **Refunds for workshops and seminars will have a deadline date, after which refunds will not be issued.**
Required
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