Sioux Empire Kennel Club
Sept 2015 REGISTRATION
Please return the following forms completed and signed: Class Application, Dog Profile, Health Certificate, Hold Harmless, Aggressive Dog Policy and Payment of $75.00 per session.
Make checks payable to SEKC. Mail to: Tammie Smart 2808 S Jonathan Lane Sioux Falls, SD 57103.
Entry into a class cannot be guaranteed without pre-registration. Class size is limited and spaces fill on a first come basis. Classes start SEPTEMBER 8TH 2015
Handler Information:
Name______
Address______
Best phone number to reach you______
Email______
Age of handler if under 18______
Dog Information:
Name______Breed______
Birth Date______Sex: Male Female Altered: Yes No
Please indicate your choice of class below.
___Puppy Play School Mondays 6:30 (starts Sept 14TH)
___Fundamentals for the family dog_Mondays 7:30 (starts Sept 14TH)
___Conformation __Tuesdays at 7:00 (STARTS SEPT 8TH )
___Agility Introduction Wednesdays 6:30 (starts Sept 9th)
___Obedience Skills Wednesdays 7:30 (starts Sept 9th)
___Novice Obedience Thursdays 6:30 (starts Sept 10th)
__Rally Skills Thursdays 7:30 (starts Sept 10th)
Sioux Empire Kennel Club
Please return with completed forms and payment
All dogs must have proof of vaccinations from aveterinarian. 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) ______
(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)