Puppy Application What is your first name? *What is your last name? *What is your email address? *What is your phone number? *Street Address *Apartment, suite, etcCity *Province *Postal Code *Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweWhat is your dog's name? *What breed is your dog? *Which gender is your dog? *MaleFemaleWhat will their age be when class starts? *Please select an option8 Weeks9 Weeks10 Weeks11 Weeks12 Weeks13 Weeks14 Weeks15 Weeks16 Weeks17 Weeks18 Weeks19 Weeks20 Weeks21 Weeks22 Weeks23 Weeks24 Weeks25+ WeeksWhich veterinary clinic is your dog registered with? *Will your dog be up to date on all vaccinations by the times classes start? For puppies, we require the second shots to have been administered or scheduled depending on their age. *YesNoDoes your dog have any allergies? *YesNoWhat are they allergic to? *Is your dog currently on any medications? *YesNoWhich medications are they currently taking? *Has your dog ever aggressively bitten another dog or a person? *YesNoWhat happened? *Is there anything else MAX Potential Dog Training should know about you or your dog? (Special considerations, past medical history, expectations for the class, fears your dog may have, etc)YesNoPlease describe *Would you like to bundle our online class with your in person class application? We offer this to our in person clients for $50 ($120 value). *YesNoAre you sure? Online allows other folks in the home that cannot come to class the ability to review the lessons and for you to submit video progress updates to be evaluated anytime. It also comes in handy in case you need to miss a class. Access remains active for 6 months. *Yes, I am sureHow did you find out about us? *FacebookFamily/Friend ReferralGoogle SearchOtherHow did you find out about us? *Course Payment OptionsYou will receive an email within a few moments of submitting this application. The email will either confirm or deny your application for obedience classes. This email may go into your junk folder. Please contact us at MAXpotentialdogs@gmail.com if you do not see the email after 5 minutes.If your application is approved, this email will also outline your options to pay the $40 non-refundable deposit. This deposit is due within one business day of our acknowledgement of your approved application. This acknowledgement is included in the email you receive after completing this application.The remainder of the class fee will be due at the end of the first class. We can accept debit, credit ($5.00 fee for credit) or cash. Please note, we do not accept personal cheques. The remaining balance after the deposit has been paid is $167.00 ($180 + $27 HST = $207 - $40 deposit = $167) for in person classes and $224.50 ($230 + $34.50 HST = $264.50 - $40 deposit = $224.50) if you opted to add online classes.The total fee for a set of six obedience classes is $207 taxes included or $264.50 including online access.Agreement *By checking this box, I certify that all information I have provided is true. I have also read and agree with the Waiver. You are not required to print or sign the waiver at this time.We require puppies to be up to date on vaccines before joining classesSubmit