Canine Massage Therapy Class
1. Owner's Information
*First Name
*Last Name
*Street Address
*City
*State
*Zip Code
*Email Address
*Home Phone
Work Phone
ex. [xxx-xxx-xxxx]
ex. [xxx-xxx-xxxx]
2
. Pet Information
*Name
*Breed/Type
*Age
*Sex
NA
8-15 weeks
4-11.5 months
1-3 years
older than 3 years
Male Female
*Spayed or Neutered?
Yes No Unsure
*Has your dog ever growled at or tried
to bite a person?
Yes No
*Does your dog bark or growl at other
dogs?
Yes No
3. Additinal Information
Name(s) of all family members
attending the class:
*How did you acquire your dog?
(Please check one.)
Humane Society
Other Rescue Group
Private Rescue
Pet store
Found/stray
Friend/neighbor/co-worker's dog had pups
Breeder
How did you select your dog?
(Optional, please describe)
4. Agreenment
I hereby make application to Annette Hamilton, Canine Massage Therapy Training Class which shall
entitle me to receive instructions on canine massage therapy techniques. I understand that my
acceptance as a class member shall entitle me to all training, but shall be limited to duration of the
course in which I am
enrolled. In consideration of my acceptance as a class member, I hereby agree to
waive any claims against Annette Hamilton and their officers and employees, for any loss or damage
which may occur to any person, animal or thing while on or adjacent to the premises.
Agree?