Behavior Training Registration Form

Name

Address

State
Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareColumbia (District of)FloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code

Daytime/Evening Phone

E-mail

PET'S INFORMATION

Dog's name

Breed

Age

At what age did you get your dog?

Sex:
Male Female

Is your dog spayed/neutered?
Yes No

Registration

I’m interested in registering for:
Group Class(es) In-Home, Private Training Session(s)*

*If interested in private training, the KHS Behavior Training Manager will contact you to discuss your needs and schedule a session.

I’m interested in the following group class: (check all that apply)
Feisty Fido ($150)
Behavior Clinic ($15)
Pet First Aid ($10)
Service Dog II ($250)
Service Dog I ($250)

Manners for Life ($85)
Positively Puppies ($85)
Manners/Puppy Combined ($85)
Beginning Agility ($85)
Advanced Beginner Agility ($85)
Intermediate Agility ($85)
Handlers Agility ($85)
Control Unleashed ($85)
Tracking ($85)
Canine Good Citizen ($85)
Tricks for Treats ($85)
Manners II ($85)
Manners II Outdoors ($85)

Would you like to sign up for two regularly priced $85 classes and save $30?
Yes No

*This discount can be applied for two dogs in one class or for one dog taking two classes. Second class can be a future class. Discounted price applies only to regularly priced $85 classes. No other discounts or coupons apply.

The class I'm registering for is at the following location:
Fern Creek – St. Alban’s Episcopal Church Highlands- Girl Scouts of Kentuckiana South Louisville- KHS Main Campus Lyndon - KHS East Campus

Please list the start date and time of the class:

If you are registering for two classes, the second class is at the following location:
Fern Creek – St. Alban’s Episcopal Church Highlands- Girl Scouts of Kentuckiana South Louisville- KHS Main Campus Springhurst – E.P. 'Tom' Sawyer State Park Lyndon - KHS East Campus

Please list the start date and time of the second class:

Do you have a gift certificate or coupon?
Yes No

If yes, please enter the code:

If your coupon does not have a code, please check the discount amount from the following options:
$10
$20

*You are required to bring your gift certificate or coupon on the first day of class in order to receive the discount. If you do not bring proof of the discount, you will be charged the full amount.

Questions and comments:

Registration Options

In order to register online, please pay the full amount for your selected class (unless you have a coupon or gift certificate). If you do not wish to pay online, you can:
* Click here to download a PDF registration form and fax it to (502) 253-2212.
* Pay over the phone with a Visa or Mastercard by calling (502) 253-2883.
* Complete the online/fax form and mail a check (made out to “Kentucky Humane Society”) to:

KHS Eastpoint Pet Resort, Attn: Behavior Manager

13310 Magisterial Drive

Louisville, KY 40223

Please read the following before finalizing your registration request.

DISCLAIMER:
This registration does not guarantee a reserved spot in class for you and your pet. Your registration will be confirmed via e-mail once received and reviewed by the Behavior Training department. Payments are non-refundable; however, you can request a class transfer if we are notified within 72 hours prior to the start of class.

FIRST NIGHT OF CLASS:
Please do not bring your dog to the first night of class, as it is orientation. We will need to see a copy of your dog's most current vaccination records. You may bring them to class or have your vet fax them to us at (502) 253-2212.

How Did You Hear About Us?
Adopted Pet from KHS Phonebook KHS newsletter/communication KHS event Family/Friend TV Radio KHS Pet Resort Drove By Newspaper KHS Volunteer Internet Other

Please specify (other, TV/radio, newspaper, etc.)

= Required