COUNTRY CANINE CARE (A Division of GREEN ACRES HOBBY FARM LTD)

COUNTRY CANINE CARE (a division of GREEN ACRES HOBBY FARM LTD)

ENROLLMENT AND LIABILITY WAIVER

Dog training/classes/services

Please complete this form with date and signature. Where there is an option please circle and initial to indicate that you have read and understood the information. Thank you.

Dog’s name: ______Male/ Female Spayed/neutered: Yes ____ No ______

Dog’s date of birth/age: ______

Owner’s information:

Name: ______

Contact number (s): cell ______home ______work ______ext ______

Address: ______

Email: ______

1) Veterinarian: ______Phone: ______

Please provide proof of the following: DA2P, Bordetella, Rabies, and flea control. Parasite control (deworming) is recommended. Initial: ______

2) Do you authorize Country Canine Care to post pictures of your dog on our Facebook Page? Y N

Do you authorize Country Canine Care to use your dog’s photo on our website? Y N Initial: ______

3)RISKS

There are risks associated with any type of group activity. While Country Canine Care takes every effort to avoid injuries, accidents and illness, there is a chance that your dog may experience one, if not all of these risks.

If a dog causes destruction of property, the owner will be held financially responsible. Country Canine Care believes in quality vs. quantity which results in small classes of 6 dogs or less and small daycare groups of 10 or less plus small groups of overnight guests of 5 or less, therefore, supervision is close with the goal of avoiding destruction, but again, accidents can happen.

In general illness, accidents and even death have the potential to occur. However, Country Canine Care is dedicated to the safe provision of training/classes/services for all dogs enrolled and takes every effort to maintain a clean, sanitized, safe environment. Initial: ______

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4) I agree to pay in full for training/classes/services prior to the beginning of session/class. Initial: _____

I release Green Acres Hobby Farm Ltd., operating as Country Canine Care, its staff, owners, representatives, and agents from any and all liability which I or my dog may suffer including but not limited to injury, illness, accident, damage or death resulting from participation in training/classes/services.

Name: ______

Signature: ______

Date: ______

Country Canine Care staff:

Sign below to indicate you have reviewed this form with the dog owner(s) and have proof of vaccination and flea treatment on file.

Witness: ______

Signature: ______Date:______

“Dogs are not our whole life, but they make our lives whole” Roger A. Caras

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