Training Scholarship Application
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Pet's Name
*
Primary Breed
*
Dogs Age
*
Where did you get your dog?
*
Please Select
Helping Hands Humane Society
Another Rescue/Shelter
Friends or Family
Other
Is your pet sterilized
*
Yes
No
Is your pet current on Vaccinations
*
Yes
No
Please describe behavioral issues with your dog that you are experiencing
*
Has your dog harmed any other person or animal in the past?
*
Yes
No
If yes, Please explain
Please explain your financial circumstances
*
Additional Comments
I understand that once I click the Submit button, my form will be sent to HHHS and they will contact me VIA EMAIL (kathy.maxwell@hhhstopeka.org) with additional details. **Mark the email address as "safe" or check your junk mail often for our communications.**
*
I understand
I understand that HHHS may contact me via text messages or phone calls regarding training classes.
*
I understand
By checking this box, I understand that participating in Helping Hands Humane Society’s training courses does provide an element of risk to both myself and my dog. In consideration of this risk, I, the owner/trainer, herby releases and agrees to hold harmless Helping Hands Humane Society and its representatives from any liability for damages or loss, if any, suffered or sustained by myself or my dog as a result of personal injury or property damage during the course of training
*
I understand
Submit
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