Clark County Dog Obedience Training Release Form

CLARK COUNTY Dog Obedience Training Release Form

(ONE FORM PER DOG)

Date

HANDLER’S INFORMATION

Name

Age (as of Jan 1st) Grade (as of Jan 1st) # of Year in Dog Project

Address and City

Phone

E-Mail Address

Parent/Guardian

In case of emergency please contact: Phone

DOG INFORMATION

Dog’s Name Age of Dog

Breed of Dog

Do you own your dog: ___ Yes ___ No Sex (check one): ___ Male ___ Female

Is your dog a house dog: ___ Yes ___ No

Vaccination papers

Vaccination papers have been checked by the supervisor and are current: o

Reminder—a COPY of vaccination papers MUST accompany your dog to the fair.

Signature of supervisor checking vet papers Date

*The fee per person is: $15.00 for Clark County 4-H / FFA members

$25.00 for non Clark County 4-H / FFA members

Checks should be made payable to 4-H Leaders Federation

RELEASE

I hereby make application to enter the above named and described dog training and agree to abide by all the rules and regulations of the training school. I will faithfully carry out the recommendations of the instructors and train my dog to the best of my ability, attend classes regularly and do as much additional training of my dog between classes as may be recommended by the instructors.

In consideration of the acceptance of this application and entering of my dog in school I agree not to hold the 4-H Dog Obedience Training School, Clark County 4-H Program, or the 4-H Dog Obedience

Instructors responsible in any way for loss or harm to myself or my dog from injury. I also agree to be responsible for my own dog if injury if caused by my dog to any other dog or to any person while in this school.

If my dog is sick or in season, I agree to leave it at home, but will attend classes and get the lesson for that week.

Signature of 4-H Member

Date

Signature of Parent/Guardian

Date

Signature of Instructor

Date

Clark County 4-H Dog Release Form Page 1