Online Application A deposit of $200 is required along with your application to ensure availability and enrollment for the course that you are applying for. All deposits are non-refundable, except in the event that we reject your application. The deposit will be considered part of your tuition when you arrive for class. If you have questions, please call us at 812.650.2394. The application fee is paid via the button towards the end of the application. Thank you - in advance! Full Name* First Last Mailing Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email Address* Gender*MaleFemaleEmergency Contact Information*name, relationship, phone numberPrevious Education*Course Applying for*Behavior/ObedienceBehavior/Obedience OnlineProtection Dog TrainerMaster TrainerScent DetectionCadaver DetectionPolice K9 InstructorService Dog TrainerDeposit Total $0.00 Select Semester Applying For*Spring - begin March though JuneSummer - begin July through Sept.Fall - begin OctoberOnline - AnytimeWill you need financing?*UnsureYesNoWill you need lodging?*UnsureYesNoHow did you hear about the Dog Trainer College?*online search, student/grad, Facebook, etc.What factor was most influential in your decision to apply here?*If you have ever been convicted of a felony or drug charge, please explain.I have read and agree to the following*YesNoI certify that to the best of my knowledge and belief, the information provided in this document truly represents me. I understand that failure to give complete information, falsification or misrepresentation of information may prevent me from enrolling in Conifer Canine's Dog Trainer College. In applying for enrollment in the Conifer Canine Dog Trainer College, I understand that this type of training can be both mentally and physically intensive and demanding. I feel as though I am in suitable physical condition to attend the course in which I have applied for and understand that if I am not physically able to perform the tasks that are required to complete the course, this may affect my overall grade and may hinder my ability to complete the course. Furthermore, I will hold Conifer Canine LLC not liable for any injury, or expenses as a result of injury, while performing tasks as a student in the Dog Trainer College. I understand there are no refunds for dropping out, and/or missed classes, and that either/or will affect my grade. I understand that during my attendance at the Conifer Canine Dog Trainer College, I will be held to a specific Code of Conduct and will be solely responsible for my actions and the actions of any personal dogs that may accompany me during the Course. I also understand that if I do not adhere to this Code of Conduct that I may be asked to leave the course with no refund of monies paid. I, the undersigned, to hereby consent and agree that Conifer Canine LLC, its employees or agents have the right to take photograph, videotape, or digital recordings of me and to use it in all media exclusively for the purpose of supporting and promoting the mission of Conifer Canine LLC. I further agree that such photographs or video footage may be used for educational and marketing purposes in Conifer Canine LLC promotional video materials and or third party use by funder or prospective funder. I also understand that Conifer Canine LLC is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as result. I understand that the Dog Trainer College is a smoke-free environment. I represent that I am at least 18 years of age, that I am the above described individual, that I have read and understand the foregoing statement/s, and am competent to execute this agreement. This consent shall remain valid until written notice is provided to the contrary. I authorize Conifer Canine LLC to bill the card below for the application deposit of $200.Your name as an electronic signature* First Last Today's Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please use the drop-downs to complete today's date.Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.