Agility Class Registration Form

LAUGHING DOG AGILITY

AGILITY CLASS REGISTRATION FORM

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Handler Name:______Home Phone #:______

Address:______Alternate Phone #:______

City/State/Zip:______E-Mail:______

Dog’s Call Name______Dog’s Breed______

Dog’s Birth Date______Dog’s Gender M_____ F______Spayed/Neuter______

Dogs must be at least 5 months old.

DOG’S VACCINATION RECORD MUST ACCOMPANY THIS REGISTRATION FORM

Your dog must have the following vaccinations to attend class:

Distemper, Hepatitis, Parvo – Within the last 3 years

Rabies – Within the last year unless proof of 3 year vaccination is provided

Bordetella (Kennel Cough) – Within last 6 months if nasal or within past year if injection. Specify which.

If dog’s vaccinations are due shortly before class starts, please notify Sara Langston and provide record on first night of class. NO DOG WILL BE ADMITTED TO CLASS WITHOUT PROOF OF VACCINATIONS.

REGISTRATION FORM IS FOR:

Agility Building Blocks A or B ______Agility Beginner______

Class Date:______Class Time:______

Class Fees: $120 for class held once a weekfor six weeks. Make checks payable to Sara Langston.

Payment should accompany Registration Form. A signed Release Agreement (Page 2) MUST be included with the Registration Form.

Send Registration Form, signed Release Agreement and Class Fee to Sara Langston, 1520 Bridge Creek Road, Prattville, AL 36067

LAUGHING DOG AGILITY, LLC

RELEASE, ASSUMPTION OF RISK, AND

AGREEMENT TO INDEMNIFY AND HOLD HARMLESS

I understand that attending a dog agility training class is not without risk to my dog, myself, members of my family or guests who may attend, and that some of the dogs attending such class may be difficult to control and may be the cause of injury even when handled with care.

As further consideration for, and as an inducement to, the acceptance of my dog into the dog agility training class to be conducted by Laughing Dog Agility, LLC, (LDA), I hereby agree to indemnify and hold LDA, its members, representatives, officers, and directors (LDA and all such persons being collectively referred to as “Indemnified Parties”), harmless from all costs, liability and expense, including (without limitation) reasonable attorney’s fees, arising or resulting from any and all claim or claims by any persons attending any training session or function conducted by LDA, or while on the surrounding area, as a result of any action of my dog.

Additionally, I hereby release Indemnified Parties from any and all liability of any nature for injury or damage which I, my family, my guests or my dog may suffer, including (without limitations) any injury or damage resulting from the action of any dog. I hereby assume the risk of such damage or injury while attending any training session or other function conducted by LDA or while on the surrounding area.

I sign this document willingly, having read and understood it. I understand that LDA would not accept my dog in such agility training classes without this Agreement and that Indemnified Parties are relying on this Agreement.

Signature:______

Print Name:______

Signature of Parent if a Minor:______

Date:______

Agreement must accompany Registration Form. Can be copied on the back of Registration Form.