Student Info

First name

Last name

Preferred Name

Pronouns

Birthday

Month

Day

Year

Parent/Guardian Info

Name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Emergency Contact

Name

Phone

Program Details

Preferred start date

Preferred days/times

How did you hear about us?

Experience & Interests

Has your child worked with animals before?

If yes, please describe:

Has your child ever helped with bathing, brushing, or grooming dogs?

If yes, please describe:

What is your child most excited to learn about dogs and grooming?

Support and Accommodations

Please share any medical conditions, allergies, or neurodivergent support needs that would help us plan for your child’s success: (MGA is a neurodivergent-affirming program)

Any physical limitations or concerns we should know about?

Authorization & Agreements

I give permission for my child to participate in the Meditative Groomer Academy Youth Program.

Parent/Guardian Signature

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Date