Lang Institute for Canine Massage Application Form To apply, please tap the PDF form to print and fill out. Student Application2024 Alternatively, you can fill out the form below online. Personal InformationName *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhone *Phone (Secondary)Email *Date of Birth *Emergency Contact InformationName *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhone *Phone (Secondary)Education OverviewHigh SchoolCollegeCollegeProfessional Licenses, Certifications, Accrediations, or Training Animal ExperiencePlease indicate how many hours of animal experience you have.Pet owner (past and present)1 dog 2-5 dogs 5-10 dogs 11+ dogsVeterinarian Assistant1 year 2-5 years 5-10 years 10+ yearsVeterinarian1 year 2-5 years 5-10 years 10+ yearsPet Groomer1 year 2-5 years 5-10 years 10+ yearsPet Shop Owner1 year 2-5 years 5-10 years 10+ yearsAnimal Shelter Worker1 year 2-5 years 5-10 years 10+ yearsAnimal Shelter Volunteer1 year 2-5 years 5-10 years 10+ yearsCanine Rescue Work1 year 2-5 years 5-10 years 10+ yearsObedience Instructor1 year 2-5 years 5-10 years 10+ yearsOther Dog Sport Instructor1 year 2-5 years 5-10 years 10+ yearsDog Show Competitor1 year 2-5 years 5-10 years 10+ yearsDog Breeder1 year 2-5 years 5-10 years 10+ yearsOther Canine Contact1 year 2-5 years 5-10 years 10+ yearsTuition Payment Plan SelectionThe Lang Institute offers four payment plans. If you choose Plan C or Plan D, we will send you a schedule of payment dates.HTML Plan Schedule of Payments Total Tuition Cost A EARLY BIRD SPECIAL! Only $3,750 if paid in full by March 1, 2024. $3,750.00 B One Payment of $3,900.00. Due two weeks before beginning Module 1. $3,900.00 C Two Payments of $2,145.00 each. $4,290. Plan B includes a 10% finance charge of $390.00. D Twelve Payments of $373.75 each. $4,485.00Plan C includes a 15% finance charge of $585.00 There will be a 3% charge on all credit card payments over $250.00 Total tuition costs may vary according to grants available.Select *After reviewing the tuition payment plans, I will participate in:Plan A: one (1) payment by March 1, 2024 for the Early Bird discounted tuition ($3,750)Plan B: one (1) payment of full tuition ($3,900) prior to enrollmentPlan C: two (2) payment installmentsPlan D: twelve (12) payment installmentsOnly select 1 option.Other ExpensesThe Lang Institute for Canine Massage will accept payment by money orders, cashier’s checks, Visa, MasterCard, personal check, or VENMO. (All material will be held for 15 days for check clearance.) Students should also expect to pay for other costs for required materials, travel, meal, and accommodation expenses and any related or ancillary expenses. These additional expenses may and can vary by region. Obtaining these required materials or incurring these expenses is the responsibility of the student. Books, charts, supplies: $175.00 – $200.00 [estimate] Four massage therapy sessions: $200.00 – $300.00 (rates can and may vary) A third-party canine CPR class: $30.00 [estimate] Travel, meals, accommodation expenses, and any other related or ancillary charges. If you are not a U.S. Citizen or a lawful resident of the United States of America, it is your sole responsibility to obtain and pay any required fees or charges for any required visa, permit, approval, or permission from the appropriate agency of the United States Government to travel to the United States of America and to be a student at the Lang Institute. ModificationsWhile every effort is made to ensure the accuracy of information in this Enrollment Application and in the Lang Institute’s Catalog, on its website, and in any other materials written or issued by the Lang Institute at the time the copy for such is prepared for publication, printing, or posting on its website, the Lang Institute fully reserves the right to make any changes, additions, and/or deletions to its Enrollment Application, Catalog, website, or any other materials written or issued by the Lang Institute without prior notice and to apply such changes to applicants and new and current students alike. Acceptance of Program Policies, Requirements, and Curriculum as specified in L.I.C.M. Catalog #4 Edition Aug. 2007-2023Select *I have fully read and understand the L.I.C.M. Catalog #4 edition Aug. 2007-2023.I fully understand the program’s curriculum, schedule, and requirements.I fully understand the program’s tuition costs and payment plans.I fully understand the program’s additional costs are my responsibility and are not included in tuition. These additional costs include, but are not limited to, books, supplies, at least four professional massages, a third-party canine CPR course, travel, meal, and accommodation expenses and other related and ancillary expenses.I have read and understand the program’s refund policy as described in the L.I.C.M. Catalog #4 edition Aug. 2007 – 2023.I understand the requirements for the Canine Massage Program include the satisfactory completion of both the Home-Study Course and the Colorado Practicum at the Institute’s location in Colorado.I am aware that canine massage is a physically demanding endeavor and acknowledge that I have the stamina, flexibility, and strength required to perform the tasks associated with canine massage.I understand there is a $150.00 application charge and will include my payment.By clicking submit, I am signing my Submission of Application.I signed up for the free ABMP Liability Insurance.Please check each and every statement to indicate you fully understand and accept the program requirements.Submission of Application *I hereby certify that all information provided is true and correct to the best of my knowledge. I agree to pay L.I.C.M. hereafter referred to as “the School,” the total stated tuition and fees. The School agrees to provide the occupational training in accordance with the provision of Catalog #4 edition Aug. 2007 – 2023 (“the Catalog”). Payment of all monies due shall be a condition of continuing enrollment. Upon satisfactory completion of all academic and skill requirements and when all financial obligations to the School have been fully met, the School will award a certificate to me stating that I have completed the training in canine massage. I and the School fully understand that this enrollment application, which includes the refund policy, may not be amended except in writing and signed by both parties. I fully understand that should any dispute or claim or any nature whatever arise between me and the Lang Institute and/or any of its officers, officials, members, employees, agents or representatives, then such dispute will be resolved or such claim will be determined under the laws of the State of Colorado. In the event of any judicial or court action or proceeding, such action or proceeding will exclusively be before the District Court of Larimer County, Colorado, U.S.A., or any court of competent appellate jurisdiction therefrom. I am including a $150.00 application charge with my enrollment application. This charge is nonrefundable if my application is not approved by the Lang Institute for Canine Massage. If my application is approved, the charge will be credited toward the full tuition of the Canine Massage Program. Mailing Address and Contact InformationHit the submit application button below to agree to all of the above. Or, print and fill out the application and send it--along with your tuition plan selection, your initialized “Acceptance of Program Policies, Requirements, and Curriculum” form, and the $150.00 application charge (made payable to Joanne Lang, Inc.) to: Lang Institute for Canine MassageP.O. Box 2786Loveland, Colorado 80539-2786 If you have any questions about this application or the program or you would prefer to fill out a PDF of the application form to send in, you may contact us at the above address, by calling 970-691-3985, or by emailing lang@dogmassage.com. You may also visit our website at www.dogmassage.com for additional information. SUBMIT APPLICATIONPlease do not fill in this field.