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Dog’s Name(Required)

Birthday

Age

Veterinarian(Required)

Vet’s Phone(Required)

Owner's Name(Required)

First Name Last Name

Email(Required)

Phone(Required)

Address(Required)

Street Address City State / Province / Region

How did you hear about Calm Canines Shopping ?

Who is your dog reactive to?(Required)

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Other dogs

People

Clients:

I understand that my dog, my guests, or I may be videotaped or photographed and that these images become the property of NorthPoint Pets & Company. I agree to release, hold harmless, acquit, will indemnify, and forever discharge the corporation from all, and in all manner of action and actions, suits, damages, judgments, executions, claims, and demands whatsoever, in law or in equity, which I or any other person I have with me during my time at NorthPoint Pets & Company. I agree that I have read and understand the terms and conditions for NorthPoint Pets & Company's Calm Canines: An Exclusive Shopping Experience.

Signature(Required)

Date(Required)

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