Lola's Place - Group Class Registration Upon submitting registration materials, someone from our staff will contact you with more class details. Payment and a copy of your dogs current vaccination records are both required prior to class. Classes held at: The Barrett Center2231 E Grand Ave, Hot Springs, AR 71901 501-282-5835

*Which class are you enrolling in?:

Puppy - (None enrolling at this time) Adult - (None enrolling at this time)

*Handler's (Your) First and Last Name:

*Address Line 1:

Street

Address Line 2:

City and Zip

*Mobile Phone:

*E-mail:

*Dog's Name:

*Dog's Age:

*Dog's Gender:

Male Female

*Dog's Breed:

If mixed breed, list two primary breeds if possible

*Is your dog spade or neutered?

Yes No

*Check Vaccines your Dog is Current on:

Rabies Distemper Parvovirus Bordetella

*Name and Phone Number of Veterinarian:

*Has your dog ever growled at or bitten another dog?:

Yes No

*Has your dog ever growled at or bitten YOU or another PERSON?:

Yes No

If you answered YES to either question above, please describe the situation:

List three things you would like your dog to learn:

ie. come when called, walk on a loose leash

List any problems or behaviors you would like to correct or learn to manage:

ie. nipping, jumping up, running out the door

*We will call you for payment after this form is recieved, which method will you be using?

Credit Card Venmo Check/Cash

Classes are limited and fill up on a first come, first serve basis. Class fees cannot be refunded after the first regular class. Classes are subject to change based on enrollment.

IN CONSIDERATION OF THE ACCEPTANCE OF THIS APPLICATION, I (we) agree to hold this school, its members, officers, agents and any employees of the aforementioned parties, harmless from any claim of loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of the dog while in or upon the training premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility. By signing below, I (we) hereby agree to the above and attest that the information provided on this form is true and accurate.

Type Name Below:

By E-Signing Your Name Here You Are Agreeing To The Terms Above:

Click "Submit" and someone will contact you soon!

Thank you!