703 Cross Street, Lakewood, NJ 08701 732-363-1001

703 Cross Street, Lakewood, NJ 08701 732-363-1001

Class Application

Name:______Phone #:______

Address:______City:______State:______Zip:______

Email:______

1:Dog’s Name ______Breed:______

Age:______Sex:______

Previous training:______

Has this dog ever bitten anyone? Yes no (circle one)

If yes, please explain:______

-Class______Day & Time______

2. Dog’s Name:______Breed:______

Age:______Sex:______

Previous training:______

Has this dog ever bitten anyone? Yes no (circle one)

If yes, please explain:______

-Class______Day & Time______

Fees: $100 for Show Handling w/ Carol Sheilds

$125 for Competition Obedience Classes w/ Ann Scripko

$135 for all Agility Classes With Ann Scripko or Lynda Hammond

$145 for all Pet Classes

Multi- class discount of $25 for the same dog enrolled in more than one class during the same session. (ex. Fideo is enrolled in SR Open and SR Utility $125 plus $100) There are no refunds 14 days prior to the start of any class. No Reactive dogs are allowed in group classes. Private lessons are required for Reactive dogs.

Make Check Payable to: Clever K9 Dog Training. Mail to: Clever K9 Dog Training LLC, 703 Cross Street, Lakewood NJ 08701

You must sign the release form on the back of this application

Clever K9 LLC Obedience Release Form

I, ______, understand that attendance of a dog training session is not without risk to myself, members of my family or guests who may attend, or my dog, because some of the dogs to which I (we) will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. I understand that the use of dog training equipment and the use of the Training facility are not without risk to myself, members of my family or guests who may attend, or my dog, because dog training requires physical movement on both my and the dog’s part.

I hereby waive and release the property owners Aliseo Property Management located at 703 Cross Street , Lakewood NJ , Ann Marie Scripko and Michael Scripko , property located at 279 Jackson Pines Rd, Jackson NJ ,Clever K9 Obedience LLC , and any instructors, or employees or family members from any and all liability of any nature or damage which my family, guests, I or my dog may suffer, including specifically, but not without limitation, any injury, or damage resulting from the action of any dog or use of equipment.

I expressly assume the risk of any such damage or injury while attending training sessions, or while on the training grounds or the surrounding area thereto. In consideration of and as inducement to the acceptance of my application for training at this facility, I hereby agree to indemnify and hold harmless the property owners, Aliseo Property Management, Ann Marie Scripko, Michael Scripko and Clever K9 Obedience LLC , and any instructors, or employees or family members from any and all claims, loss and expenses , including legal fees, or claims by any member of my family or any other person accompanying me to any training session, by reason of liability imposed by law upon the aforementioned party for the damage because of bodily injuries at any time resulting there from, sustained by the aforementioned party or may be alleged to have caused by negligence of the aforementioned party or any of the person. I expressly accept to pay all damages incurred by my dog, regardless of fault, to any property, person or animal while my dog is on The property located at 703 Cross St, Lakewood NJ or 279 Jackson Pines Rd, Jackson NJ.

Signature:______

(or signature of legal Guardian if handler is under the age of 18)

Print Name:______

Date:______