Animal Medical Center / Enrollment Form

Animal Medical Center
Your Pet's Second Best Friend


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Puppy Preschool Enrollment

Please complete the form below to enroll your puppy in a Puppy Preschool. Please feel free to call or email us if you have any questions before (or after!) enrollment. After we receive your enrollment, we will contact you to confirm your registration.

Thank you for your interest in our Puppy Classes. We are excited to offer this program and we are confident that you and your puppy will have a great time and learn a lot! We look forward to seeing you in class soon!

Form - Puppy Preschool Enrollment

Name (required)
First Name (required)	Last Name (required)

Address (required)
Street Address (required)


City (required)	State/Province (required)	Zip/Postal Code (required)
,

Phone (required)
Phone Type	Phone Number (required)

Phone
Phone Type	Phone Number

E-Mail Address (required) :

Puppy's Name (required)

Puppy's Age Today (number of weeks) or Birth Date (required)

Puppy's Breed (required)

Puppy's Color (required)

Select Your Class (required)
(Select One)
May 19 to June 30 (no class Memorial Day, May 26)
July 7 to August 11
*August 25 to September 29 * note that Sept 1 is Labor Day and that class will be held on Tuesday that week
October 13 - November 17

Medical History

Where has your puppy received his most recent veterinary care? (required)
AMC. You should have all of my puppy's medical records.
AMC and another veterinarian. I will fax, mail or drop off records of any care received elsewhere so that you can review the record before class begins. *Please note the name & number of your veterinarian in the Additional Notes section below.
Another veterinarian has provided my puppy's medical care. I will fax, mail or drop off a copy of his medical records before class begins. *Please note the name & number of your veterinarian in the Additional Notes section below.
My puppy hasn't seen a veterinarian yet. Please contact me to schedule an appointment.
My puppy hasn't seen a veterinarian yet. I will arrange for veterinary care.

Rabies & DAPP Vaccines (required)
My puppy has completed his "core" (Rabies & DAPP) puppy vaccines at AMC or another veterinarian (or will have done so before classes begin) including at least 3 DAPP vaccines and one Rabies vaccine.
My puppy has begun his vaccine series and will have them completed before the first class.
My puppy still needs vaccines. Please contact me to schedule an appointment.
I am not sure if my puppy has everything he or she needs. Please contact me to help me figure out if my puppy needs further vaccines and to schedule needed services if needed

Bordetella (Kennel Cough) Vaccine (required)
My puppy has already received at least one intranasal bordetella vaccine (or will have done so at least 3 days before the first class). Written proof of vaccination required if performed away from AMC.
My puppy has already completed a series of at least two injectable bordetella vaccines (or will have done so at least 3 days before the first class). Written proof of vaccination required if performed away from AMC.
I don't know if my puppy is adequated protected against bordetella. Please contact me to discuss bordetella vaccine and to arrange for needed care.

Intestinal Parasites - check all that apply (required)
My puppy has been dewormed by a veterinarian.
My puppy has had a "negative" fecal exam.
My puppy is taking monthly heartworm preventative (Interceptor, Sentinel, Heartgard or Revolution).
I don't know my puppy's fecal testing or deworming status. Please contact me to discuss intestinal parasite control and to arrange needed care.

Health Concerns (required)
My puppy has not had any illness and is currently healthy. My puppy does not have diarrhea or have weepy eyes, nose, sneezing or coughing or any rash or other signs of illness. My puppy is free of fleas, ticks and earmites.
My puppy has had some medical issues. Please review his/her medical record and let me know if he or she is OK to participate in class.
I don't know if my puppy is healthy enough to participate. Please contact me to discuss my concerns.

Additional Comments or Instructions

Animal Medical Center
460 Hartman Run Road
Morgantown, WV 26505
(304) 292-0126

Your Pet's Second Best Friend