REGISTRATION FORM-(Hint-Use Insert Key)

REGISTRATION FORM-(Hint-Use Insert Key)

Remember, the first night we will all meet together at 7:00 without our dogs.

Classes beginning (please write start date here)______

Over 6 mos. ______Under 6 months ______

Plan to attend Basics? ______Basics Date______

Name of Owner or Person Training dog ______

Address ______City______Zip______

E-mail Address______Occupation______

Home Phone ______Business Phone______

Call Name of Dog______Breed______Age______

Sex______Spayed/Neutered? ______Age when Spayed/Neutered______

Age Obtained______From Where______

Have you owned a dog before ______Breed (s)______

Have you trained a dog before ______When ______Where ______

State briefly any problems that brought you to class:

What do you hope to accomplish?

Do you have any hearing or other physical handicaps?

Does the dog have any physical problems or disabilities that may affect his training?

If your dog has had any illness, internal parasite or skin disorder in the last 6 months, state the nature of the problem and whether treated by a veterinarian.

Name of Veterinarian:

Date of last Distemper/Parvobooster: Date of Last Fecal Exam: Results:

Rabies Vaccination No. ______Date of Rabies Vaccination______

What kind of dog food do you feed? Brand, canned, dry, etc.

How did you hear about our classes?

Has your dog ever bitten or threatened to bite a person or another dog?

Please Check One

I have enclosed a check for $100.00 to pay for the class. ------

I will pay at the 1st class. ------

Do not mark below this line______

WK 1 WK 2 WK 3 WK 4 WK 5 WK 6 WK 7 WK 8

I understand that attendance of a dog obedience training class 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 hereby waiver and release Shadowland Kennels, its employee, owners and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of any such damage or injury while attending any training session or other function of the School, 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 membership in the obedience training class, I hereby agree to indemnify and hold harmless members of my family or any other person accompanying me to any training session of function of the School or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

Signature of Owner or Authorized Agent X______

Date X______