Obedience Training

In association with Moosehead Trail Boarding Kennel

207-368-2442

Class starting date and time: ______

Location:______

Owner’s Name: ______Phone #: ______

Complete Mailing Address: ______

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Email Address: ______

Dog’s Name: ______Approximate Age: ______Sex: ______

Breed (if mix give best guess): ______Neutered? ______

What do you hope to achieve from the class? ______

______

Has your dog ever bitten (even nipped) anyone? ______If yes, what were the circumstances? ______

______

______

______

Are you interested in competing with your dog? ______

If yes, are you interested in Obedience, Conformation, or Field Trials? ______

______

Have you ever attended Obedience classes before? ______If yes, with whom and when? ______

______

Please complete page 2

Agreement (please initial each line statement)

  1. I understand the first week, which is orientation, is mandatory attendance, and if I miss it, I cannot attend the

following weeks in this session. ______

  1. I understand that there are no waiting lists for this class and that the enrollment is limited, therefore my registration fee is not refundable if I should choose to drop out for any reason. ______
  1. I understand that I am solely responsible for the safety of my dog, any spectator I may bring, and myself. I agree to hold the facility and the instructor harmless should any injury occur as a direct result of attending this class. ______
  1. I understand that photographs and/or video may be taken during class sessions to be converted to DVD or posted on the Back to Basics Obedience website and agree to this activity. ______

Signed: ______Date: ______

Registration must be signed and payment included to be valid.

Make checks payable to: Betsy Newman

Mail all registrations to: Moosehead Trail Boarding Kennel, 101 Fernald Road, Newport, ME 04953

We accept Mastercard, Visa, and Discover

Card # ______Exp. Date ______3 digit code on back of card ______

Signature ______

* You will receive a call to confirm a spot in the class once the paid registration has been received. Please call 368-2442 with any questions.

Child Attendance Agreement

1. I agree to provide adult supervision for any child under the age of twelve that I may bring to class. ______

2. I understand that, ______, my child can participate in the class providing the child is

physically capable of restraining the dog, and that a parent or guardian is in the facility at all times.______

3. I understand that I may follow my child around the floor, but that my child cannot follow me around the floor

during the training. ______

  1. I understand that the instructor must be able to be heard at all times, therefore, I agree to remove my child if

he/she is disruptive to the class. ______

  1. I understand that my child’s safety is my responsibility. ______
  1. I understand that by participating in the class, my child may be part of the class photographs and/or video for the Back to Basics Obedience website and agree to this activity. ______

Signed: ______Date: ______