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Name
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First
Last
Phone
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Can I text you at this number?
*
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Email Address
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Dog's Name
*
Age at time of start date?
*
Current Weight
*
Sex
*
Male
Female
Spayed / Neutered
*
Yes
No
Breed / Mix
*
Color / Markings
*
Any health concerns to be aware of?
*
Yes
No
Please explain:
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Any additional information that we should know?
*
Yes
No
Please explain:
*
Veterinary Clinic Name
*
Vaccination Records (If not able to upload, please bring proof of vaccinations to the first class)
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Date
*
Month
Day
Year
Consent
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Rescheduling and Cancellation Policy
Consent
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I agree to the
Training Release of Liability Agreement
Therapy Dog Prep
*
Price:
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