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BANDILANE SCHOOL FOR DOGS, INC.
JOYCE DIAMOND, CPDT-KA
80 LARGO DRIVE, STAMFORD, CT 06907  *  PHONE: (203) 975-8151  *  FAX: (203) 975-7457

PLEASE COMPLETE APPLICATION - PRE-REGISTRATION IS REQUIRED


OWNER'S NAME
ADDRESS
CITY
STATE
ZIP
HOME PHONE
WORK PHONE
CELL PHONE PROVIDER
CELL PHONE
FAX
EMAIL ADDRESS
EMERGENCY CONTACT
CONTACT'S PHONE
DOG'S NAME
DATE OF BIRTH
OWNED SINCE
BREED
DOG'S BACKGROUND?
VETERINARY
HOSPITAL
VETERINARIAN'S
PHONE
IS DOG IN GOOD HEALTH?
IF NO,
EXPLAIN
IS DOG ON ANY
MEDICATIONS?
IF YES,
EXPLAIN
DOES DOG PLAY OFF-LEASH WITH OTHER DOGS?
FREQUENCY
OF PLAY?
HOW DOES
DOG PLAY?
IS DOG AFRAID OF ANYTHING OR ANYONE?
IF YES,
EXPLAIN
WHAT DOES DOG DO?
HAS DOG
GROWLED AT
ANYONE?
IF YES,
EXPLAIN
HAS DOG
EVER BITTEN?
IF YES,
EXPLAIN
ANY FORMAL TRAINING?
TRAINER
OR SCHOOL
LEVEL OF
TRAINING
DOG KNOWS
SIT
DOWN
STAY
LEAVE IT
COME
HEEL
HOW DOES DOG GREET PEOPLE?
REFERRED TO
BANDILANE BY


PLEASE REGISTER MY DOG FOR THE CLASSES BELOW:
Please see  Agility Classes  -  Pet Training  for descriptions







TUITION
$300* for All 8-Week Classes
$262* for All 7-Week Classes
$225* for All 6-Week Classes
*Plus Applicable 6.35% CT Sales Tax

Please make check payable to BANDILANE SCHOOL FOR DOGS, INC.
or we can take your credit card over the phone 203-975-8151.
Sorry, but we do not take American Express.

Space is Limited!
Payment, in full, must be received
to reserve your spot in class.

REFUND POLICY:
Prior to start date, FULL REFUND
Between Week 1 and Week 2, 50% REFUND
After Week 2, NO REFUNDS AND NO CREDITS



WRITTEN PROOF OF VACCINATIONS IS REQUIRED
You may fax copies to us at 203-975-7457

Distemper and Parvovirus, Rabies* -- Titers Accepted
*Rabies not required for Puppy Class

Bordetella (Kennel Cough) also required for Daycare

__________________________________________________________________________________________________________________

BY APPOINTMENT ONLY  -  PLEASE REGISTER MY DOG FOR:
DAYCARE
PRIVATE LESSONS
PROFESSIONAL GROOMING

__________________________________________________________________________________________________________________

COMMENTS:


__________________________________________________________________________________________________________________

I will not hold Bandilane School for Dogs, Inc., 80 Largo Drive, Stamford, CT, Joyce Diamond,
any trainer teaching at Bandilane School for Dogs, Inc., any employee, groomer, or anyone
associated with them responsible for injury to persons or property caused by my dog or any dog
brought by me. Nor will I hold them responsible for physical harm which might come to me or my dog
while on the premises of Bandilane School for Dogs, Inc. or off premises in a group or private lesson.

I agree to the terms above.






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