Download Application here (Get Adobe Reader)

Download Application here (Microsoft Word Users)

Mail To:

43300 E. Pleasant Ridge Rd. 
Hammond, LA 70403
(985) 634-9339


ENROLLMENT APPLICATION

Enrollees Name: _________________________________Date: _________________

Date of Birth: __________ Social Security Number: ____________________________

Driver’s License Number and State of Issuance: ________________________________

Home Address: __________________________________________________________

Telephone: (Home) _______________________ (Work) _________________________

BACKGROUND INFORMATION: PLEASE ANSWER ALL QUESTIONS:

Grade Level Completed: ( ) High School ( ) College ( ) Post Graduate

Are you currently employed? ( ) Yes ( ) No

Name and Address of Current Employer: _______________________________________

Phone Number of Current Employer: _________________________________________

Please list two references:

Reference (1) _________________________________Relationship: ________________

Address:________________________________________________________________

Telephone: ________________ How long have you known this person? _____________

Reference (2) ________________________________ Relationship: ________________

Address: ________________________________________________________________

Telephone: ________________ How long have you known this person? _____________





IN CASE OF EMERGENCY, PLEASE NOTIFY:

Name: ___________________________________ Relationship: ___________________

Address: ________________________________________________________________

Phone: (Home) _________________ (Work) __________________ (Cell) ___________



Have you had any prior grooming experience? ( ) Yes ( ) No

________________________________________________________________________

I understand that as a trained professional groomer, I must enjoy dogs. It is important to have patience, common sense, and a sense of humor. I must be dedicated to good work ethics and strive for development of creative ability.

Smock size: ( ) Small ( ) Medium ( ) Large ( ) X-Large

Please accept my application for enrollment in the Pet Grooming Academy of Louisiana this ______ day of _____________, 2012. Enclosed is my  registration fee of $25.00

Enrollee’s signature: ______________________________________________________

Representative: __________________________________________________________

Parent/Guardian (if applicable): _____________________________________________

( ) Cash ( ) Check ( ) Credit Card

Expiration date _________________________________

Signature on card _______________________________