Welcome to the Academy of Dog Grooming

Academy Of Dog Grooming
1742 West Algonquin Road
Arlington Heights, IL 60005
Attn: Sharron Panther, C.A.H.
(847) 454-7300 / (800) 333-9034

Application for Enrollment

Instructions
Option A: 1) Complete this form 2) Press SUBMIT.	Option B: 1) Complete this form 2) Print form 3) Date & sign your name on the bottom of the last page. 4) Send application along with $100.00 check (nonrefundable) payable to the Academy of Dog Grooming Arts to the address above.

Reminder: Students must present evidence of a recent tetanus inoculation on the first day of class.

Please accept my application for

Requested Start Date

Enclosed is my registration fee of $100.00 (nonrefundable). Complete registration will be made at scheduled time of enrollment.

PLEASE CALL FOR FUTURE STARTING DATES & TOURS.

PERSONAL INFORMATION

Name
Street
City
State	or Provence
Zip Code or Postal Code	Country
Home Phone
Work Phone
Email
Emergency Contact	Name Phone Number
Birthdate	(month/day/year)
Sex	Male Female

Is housing required?	Yes No
Right handed
Left Handed

Payment Type:
Credit Card Number:
Expiration Date:

Below this line is for Option B only

Your Signature here X	__________________________________________
Date (month/day/year) X	__________________________________________