Workshop Intake Form Please fill out all required fields for form to properly submit. To check if form has submitted, click "Fill out intake form" button again. "*" indicates required fields Name* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Dog's Name* Dog's Breed* Which workshop would you like to register for?*Nail Trim WorkshopBathing/Drying WorkshopBrushing/Dematting WorkshopI understand that full payment is due at the time of registration. Please initial.*Please initial at the bottom of each of the following to indicate that you've read and agree to the following terms: I understand that in the event of severe weather or other emergency workshops may be postponed to the following week at the trainers discretion. Please initial.* I accept all liability if any humans or dogs are harmed during training sessions. Please initial.*
