Note: * indicates a required field

Name: *

Email Address: *

Street:

Suite, Unit, Apt:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Cell Phone:

Please check all that apply.

Male

Female

Right Handed

Left Handed

I live select more than less than 50 miles from school.

I live in a(n) select rural suburban urban area.

Have you attended any schools beyond high school? select yes no

Present Occupation:

How Long?

Do you have previous experience in the pet care field? select yes no

If yes, please explain:

Please check all that apply.

Newspaper

Yellow Pages

TV

Magazine

Friend

Groomer

Magazine

Internet

Other

Which program are you interest in applying for?

80 hr Bather/Brusher

240 hr Fast Track

600 hr Career Track

*If accepted for training, when would you like to begin?

*Paragon will call to confirm your actual class start date

Please indicate what weekly class schedule you would like:

AM session 8:30-12:30

PM session 1:30-5:30

How would you like to finance your education?

One payment on the first day of class

3 equal payments

*12 monthly payments

*24-36 monthly payments

other

*credit application required

Would you like to purchase a tool kit from Paragon? select yes no

Name: *

Relationship: *

Email Address: *

Street:

Suite, Unit, Apt:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Cell Phone: