VIDEO CONSULT or PRIVATE REQUEST FORM
Please provide your contact info, dog's info, and describe in detail the goals you have for your dog, or the problem(s) you want help with.  
Sign in to Google to save your progress. Learn more
Owner's Name *
Street Address *
Apt #/PO Box #
if applicable
City *
State *
Zip Code *
Main Phone # *
Is Main Phone #
Clear selection
Secondary Phone #
Is Secondary Phone #
Clear selection
Email Address *
Email is the preferred method of communication.  
Dog's Name *
(Call name; not registered name)
Dog's Breed *
Dog's Age *
please indicate age in years and/or months
Dog's Sex *
What goals do you have for your dog and yourself?  ie, Therapy Dog work, Agility, Obedience, Hiking Buddy, Companion, stop jumping on people, coming when called, etc *
Please describe the main problem(s) or issue(s) you would like to resolve through training, that we should cover during the consult. *
First Preferred Day/Time (check all that apply) *
Please check the schedule for the days/times your class(es) are being offered.  Review the current schedule.  By checking days/times, you are indicating you are eligible to take classes during those time slots.
Required
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 Rabies Vaccination was given (dogs under 16 wks of age exempt) *
Please indicate month and year of current rabies vaccination
Date of Distemper/Parvo/Parainfluenza *
Please list the most recent date DHPP was given
Date Bordatella Vaccination was Administered *
Give date of most recent bordatella vaccine.  (We personally recommend the intranasal version) Current = vaccine was given within 6 to 12 mo
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.
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.
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.**  Students are responsible for checking the following resources for weather or emergency cancellations:  www.paw                                                                      andhand.com; Paw & Hand Obedience fb page and/or fb group, outgoing message on 570-980-1546; email; Paw & Hand Google Group.  Cancellations are posted 2 hrs prior to the start of the earliest class of the day or evening.  For example, Mon AM classes start at 9:30AM so the cancellation notice would be posted by 7:30AM.  If classes start at 6pm, the announcement will be made by 4pm.  
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms