Sioux Empire Kennel Club

Sioux Empire Kennel Club

September 2018 Class Registration

Please return the following forms completed and signed: Class Application, Dog Profile, Health Certificate (VET PROOF of RABIES) , Hold Harmless, Aggressive Dog Policy and Payment of $90.00 (non-member) $70.00 (member)

Make checks payable to SEKC. Mail to: SEKC c/o Tammie PO box 719 Sioux Falls, SD 57101.

Entry into a class cannot be guaranteed without pre-registration including all documents and payment. Class size is limited and spaces fill on a first come basis.

Handler Information:

Name______

Address______

Best phone number to reach you______

Email______

Dog Information:

Name______Breed______

Birth Date______Sex: Male Female Altered: Yes No

Spring Schedule

Starts February 26th

All classes are for 50 minutes and the session goes for 6 weeks

Please indicate which class you are signing up for below (circle one, highlight, etc)

MONDAYS

·  Puppy Play School- For puppies 12 weeks to 20 weeks. 6:30PM (Hollie and Cindy)

·  Rally Skills 7:30pm (Hollie)

TUESDAYS

·  Puppy Play School- For puppies 12 weeks to 20 weeks. 6:30PM (Maggie

·  Conformation -7:30pm

WEDNESDAYS

·  Advanced Agility Class 6:30 pm

·  Introduction to Agility- 7:30pm

o  MUST BE OVER 1 YEAR OLD FOR AGILITY CLASSES

THURSDAYS

·  Fundamentals 1 for dogs over 5 months who have not had obedience training.

·  Fundamentals 2 pre-req fundamentals 1

Sioux Empire Kennel Club

Please return with completed forms, record from vet and payment

All dogs must have proof of vaccinations, rabies must be from a veterinarian. A copy of vaccination record from aveterinarian office showing the following is REQUIRED before anyone may enter a class. Once all documents are received you willreceive an email stating you are registered for the class. Registration is on a first come first serve basis so register early and get all documents in early to ensure getting in the class you want.

NAME OF DOG______

BREED______AGE______

NAME OF OWNER______

VACCINATION RECORD SHOWING DATES OF MOST RECENT BOOSTER(S) or Titers

Puppies series are usually given around 10 weeks, 15 weeks and one year

Distemper and Parvo #1______#2______#3______

RABIES (REQUIRED) ______must have record from vet______

(20 weeks or older (must have two doses initially) then every 3 years in South Dakota (required by law)

**Not applicable if puppy is under 4 months of age**

Dogs over 1 year of age may provider proof of immunity with titers every 3 years on all

vaccines except for rabies as required by law.

INTRANASAL BORDETELLA (RECOMMENDED) ______

Puppies must be wormed, no fleas, and it is highly recommended puppies have a fecal exam within 30 days of class.

Sioux Empire Kennel Club

Dog Profile

Please fill out for every dog regardless of class entered.

Handler Information:

Name______Best Phone Number to call______

Email______

Dog Information:

Name______Breed______Birth Date______

Sex Male Female Altered Yes No

Do you or your dog have any physical conditions that may affect your training abilities: Yes No

If yes, please describe:

Where did you get your dog?

Shelter/Rescue Program_____ Professional Breeder_____ Pet Shop _____ Neighbor/Friend_____

Other (please explain) ______

How old was your dog when you acquired it? ______

Is your dog uncomfortable around: Men_____ Women _____ Children_____ Strangers_____

Crowds_____ New, unfamiliar dogs______Large/Small dogs______Active or rowdy dogs______

Will your dog play with toys away from home? ______Eat treats away from home? ______

Have you previously attended dog training classes with SEKC? Yes No

Please list the most recent class you have taken with us: ______

SIOUX EMPIRE KENNEL CLUB

Agreement to Hold Harmless, Waiver and Assumption of Risk

I understand that attendance of a dog at obedience, conformation or agility 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 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 waive and release the Sioux Empire Kennel Club hereinafter referred to as the SEKC, its employees, officers, members, and agents from any and all liability of any nature or injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session, or any other function, of the SEKC or while on the grounds or the surrounding areas as a result of any action of any dog including my own.

Name of Owner______

Street______City______State______

Signature of owner______

(In case of minor, Parent or Guardian must sign)

Aggressive or Disruptive Dog Policy

Any dog that exhibits unsafe or disruptive behavior toward other dogs, handlers, or instructors must be immediately brought to the attention of the Class Coordinator. A further evaluation of the dog’s behavior will be performed by the Instructor and the Class Coordinator and if it is determined that the dog will not benefit from the group class situation or poses a safety problem, the dog will be dismissed from class immediately. A partial refund will be given to the handler along with a referral to someone that might be able to help.

I understand the above policy and agree with any decision regarding my dog(s) aggressive or disruptive behavior.

Name of owner: ______

Signature of owner: ______Date:______
(If minor, parent or guardian must sign)

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