COURSE REGISTRATION

Please fill out this form with as much information as possible. You will then be directed to PayPal's secure payment page. FULL PAYMENT is required to secure your spot in a class. You do not need a PayPal account, and you can pay with any major credit card. Your registration will be confirmed via e-mail after receipt and review of this registration form. If you have any questions, please contact Jennifer at dttw@canis.ca.

SECTION 1: REQUIRED OF ALL REGISTRANTS
First name (*):
Last name (*):
Address 1 (*):
Address 2:
City (*):
Province/State (*):	Province/State ===Canada=== Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Yukon ===United States=== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming OUTSIDE US AND CANADA
Postal/Zip (*):
Phone number (*):
E-mail (*):
Re-type email (must match above) (*):
Dog's name (*):
This is a returning dog and I have previously filled out Section 2:	Yes
SECTION 2: REQUIRED IF YOUR DOG HAS NOT TAKEN A COURSE PREVIOUSLY AT DTTW
Breed (*):
Date of birth (*):	Month January February March April May June July August September October November December   Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Sex (*):	Male  Female
Spayed or neutered (*):	Yes  No
Aggressive towards (check all that apply):	Food  Toys  Bones  Furniture  Dogs  People Children  Fear  Dominance
Excessive barking (when, why):
Suffer any of the following:	Fear  Phobias  Shyness  Excitability Easily distracted  Medical illness  Physical limitations
Please list and explain any other concerns or problems that you are having with your dog:
Is your dog on any medication (*):	Yes  No
If on medication, list and explain:
Which veterinarian clinic do you use (*):
Is your dog fully vaccinated (*):	Yes  No
Has your dog had formal training before (*):	Yes  No
If so, where:
What commands can your dog perform reliably without food as a reward:
What food is your dog eating (*):
What do you want to accomplish with your training:
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Verify (*):