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FPR APPLICATION 2012

FurPeace Application Form: Personal Information

The Fur Peace Ranch has the right to refuse any application or student, but does not discriminate based on sex, race or religion. Student/instructor ratio is approximately 10:1, or less; therefore, spaces are limited and reserved on a first come, first serve basis. Workshop spaces can only be held with a deposit and a signed application. (see tuition information for application requirements.)

Gift Certificates: If you are purchasing a gift certificate please fill out sections A, D, E & F only. Mail to FPR, 39495 St. Clair Rd., Pomeroy, OH 45769 or fax to 740-992-9126.

Someone will contact you by telephone ONLY if there are questions or registration problems. You will receive a confirmation of your registration as well as an invoice and student booklet. We try our best to be gentle with our planet's resources. With this in mind, we will e-mail these items to you (whenever possible) rather than the paper and postal route.

Students applying for 2012 classes are subject to the rules terms, conditions and prices of listed in the 2012 tuition information.

By submitting the application you are entering into a legal binding contract with Fur Peace Ranch, Inc. and acknowledging that you have read and understand all of the rules, regulations and cancellation policies of the Fur Peace Ranch, Inc.

If you'd like to pay by check, you may submit an application online, however, it will not be processed until your deposit is received. Checks should be made out to Fur Peace Ranch and be mailed to: Fur Peace Ranch, 39495 St. Clair Rd., Pomeroy, OH 45701.

Questions marked with asterisks must be completed.

First Name *
Last Name *
Street Address *
Business Address
City *
State *	AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY
Zip Code *
Country *	United States Canada Other
Name Of Country
Occupation

Gender *	Male Female
Birthday *
Phone Number *
Cell Phone *
Email Address *
Name of Parent / Guardian (if under 18)

Emergency Contact Name *
Contact Number *

Emergency Contact(2) Name *
Contact Number *

Allergies	No Yes
Explanation/Medicines
Special Dietary Requirements
Any other medical conditions of which our staff should be made aware

Have you attended the Ranch before? *

No Yes