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My Polite Pooch
Dog Obedience
Contact Information
Nancy Becker
516-395-3277
Nancy@kpsearch.com
Please fill out your contact information below.
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How did you hear about us?
*
Word of mouth
Friend/Relative
Craig's List
PennySaver
Search Engine
Other
Pet Parent's Name: (First, Last)
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Dog's Name
Dog's Breed
*
Pet's Age
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Younger than 6 months
6 months to 1 year
1 to 2 years old
2 to 3 years old
3 to 6 years old
6 to 8 years old
8 years and up
Is your pet Spayed/Neutered?
Yes
No
Is your pet updated on Vaccinations?
Yes
No
Address
City, State & Zip
*
Home Phone
Work Phone
Cell Phone
Email Address
*
Email Address Confirmation
*
Please describe what services you would be interested in
*