Class Registration Form
For New Dogs / Students
***Fill the form out entirely, then print it out and mail to the address located below:
| Class Start Date & Time: | ||
| Class Name: | ||
| Name of Owner: | ||
| Mailing Address: | ||
| City: | ||
| State: | California | Zip Code: |
| Home Phone: | ||
| Work Phone: | Breed: | |
| Email: | ||
| Name of Dog: | ||
| Date of Birth: | ||
| Check all that apply: |
Male
Female Neutered/Spayed Age Obtained: |
|
| Name of Veterinarian: | ||
| Vac.Exp. Date: | Rabies: DHLPP: | |
| Has your dog ever bitten another dog to the point the other dog had to go to the Vet: No Yes |
||
| How
did you hear about our classes? |
||
| Are
there any specific training problems? |
||
| What
is your Goal for this class? |
||
| Do
you have any hearing or other handicaps/health problems which could
need special consideration? |
||
WAIVER
ASSUMPTION OF RISK AND AGREEMENT TO HOLD HARMLESS
I understand that attendance in a dog training class is not without risk to myself, members of my family, attending guests, or my dog. Some of the dogs to which I will be exposed may be difficult to control and could be the cause of injury even when handled with the greatest amount of care.
I hereby waive and release Eileen Harnedy, The Canine Academy and their employees and agents from any and all liability of any nature, for injury or damage resulting from the action of any dog. I expressly assume the risk of such damage or injury while attending any training session or while on the training grounds or the surrounding area thereto.
In consideration of and as inducement to the acceptance of my registration for training I hereby agree to indemnify and hold harmless the above named organizations, their employees and agents from any and all claims by any member of my family or any other person accompanying me to any training session or while on the grounds or surrounding area thereto as a result of any dog, including my own.
Signature: Date:
Copy of Rabies Certificate is required for participation. Send with registration form or bring to first class.
Print this form out and mail it to:
Canine Academy, 13655 San Antonio Road, Atascadero, CA 93422
**Be sure to include your payment with the registration form. Money Orders or Checks should be made out to either Canine Academy or Eileen Harnedy.
