NVAC Dog Class Sign Up Form

Date

Owner's Name

Home Phone

Address

City

State

Zip

Work Phone

Cell Phone

E-mail

Driver's License No.

Social Security No.

Spouse/Other Name

Spouse's Cell Phone

Spouse/Other Contact Phone

Whom may we thank?

TELL US ABOUT YOUR PET. (Please Submit a New Form for EACH Pet)

Dog's Name

Breed

Color

Dog's Age or D.O.B.

Male

Female

Spayed

Neutered

Where did you get you dog?

Breeder	Rescue
Paws and Claws	Other

Are there any behavior issues you are concerned about with your dog?

Has your dog attended any formal training classes? If yes, please explain.

What does your dog already know how to do?
What are you proud of or happy about with your dog?

Does your dog have any health issues or restrictions which may affect his/her ability in class?
If so, please explain.

Your Dog's Vaccination History

Rabies

Yes

Date of last Rabies Vaccination

DHLP Parvo Corona

Yes

Date of last DHLP Parvo Corona Vaccination

Bordatella

Yes

Date of last Bordatella Vaccination

Fecal Stool Sample

Yes

Date of last Fecal Stool Sample

Heartworm Test/Prevention

Yes

Date of last Heartworm Test/Prevention

Has your dog had any previous surgeries/illnesses? If so, please explain.

Is your dog allergic to any medication/vaccination? If so, please explain.

To prevent the spread of infectious diseases, all canine students must be current on all vaccines and free from internal and external parasites. By clicking on the SUBMIT button below, you agree to provide proof of vaccinations/dewormings/fecal resuts by the start of the first class.

By submitting this form, I agree to be responsible for authorizing and/or paying for services at the time of enrollment: 1st night of class.

* Indicates Response Required

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