Course Registration Form

Trainer Enrolment Form

Please fill out the form carefully. All fields required
Student Name *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail *
example@example.com
Phone Number *

Area Code Phone Number
We want to get to know our trainers. Tell us about your experience with dogs... *
Tell us how you would handle a situation where a student arrives with a dog who is clearly too aggressive or unmanageable to participate in a class? *
Teaching canine first aid is a physically demanding job. Are you capable of being on your feet for long periods of time, bending down and lifting up to 50 lbs? *
Tell us what teaching canine first aid means to you... *
Course tuition - $1,299 GST/PST included

*Tax deductible*
- Tuition must be received with application. If the student is not accepted, a full refund will be made.
- Refunds are not issued to students who withdraw from or who fail the course.
Discount Code? Enter it here:
Method of Payment *
Part of your trainer package is a logoed Trainer T-Shirt - please indicate your size below - they are Unisex
If there is anything else you wish to add, please enter it here:
Please verify that you are human *
Should be Empty:

Trainer Enrolment Form