Test application « Cape Province Dog Club

About You

Name*

First Last

Address*

Street Address Address Line 2 City ZIP / Postal Code

Phone Home*

Phone Work

Cell

Email*

Is This Your First Dog?*

Yes
No

Have You Trained a Dog Before?*

Yes
No

Where Did You Hear About the Club?*

Your Vets Name

Other (Please Specify)

What Made You Choose Our Club?*

About Your Dog

Dog's Name*

Breed*

Date of Birth*

DD

MM

YYYY

Sex*

Male
Female

Spayed/Neutered*

Yes
No

Has Your Dog Been to Training Before?*

Yes
No

Do You Have Any Problems With Your Dog?*

Yes
No

Please Describe Any Problems You Are Having

Do You Have Any Other Dogs?*

Yes
No

Other Dogs

Please list your other dogs here. Separate with commas.

Course*

Beginner's
Behavior Management

Select a Fee*

Full (R500)
Pensioner (R250)

Engraved dog tag required - additional cost of R25.00

Order dog tag (@R25)?

Yes

Select a size

Small
Medium
Large

Dogs name*

Phone number*

I understand that all training is at my own risk and that the Cape Province Dog Club and Pinelands Primary School are in no way liable for any injuries sustained by either my dog or myself in the course of training. I guarantee that my dog is properly immunised. I further understand that I may be held responsible for any damage caused by my dog or myself. I agree to conduct myself in a responsible manner and to follow instructions given by trainers.