Application for Obedience Class
Companion Dog School

 

Owner's Name: _____________________________
(As You Want it to Appear on Certificate Upon Graduating)

Address: __________________________________

Home Phone: _____________ Cell Phone: _______________

Email Address(s): __________________________________

Dog's Name: _____________________________
(As You Want it to Appear on Certificate Upon Graduating)

Dog's Age: Year ___ Months ____
Male/Neutered Female/Spayed (Circle)

Breed: _________

Has This Dog Bitten a Person? Y / N
If yes, describe the incident: _____________________________
___________________________________________________
___________________________________________________

Has This Dog Bitten Another Dog? Y / N
If yes, describe the incident: _____________________________
___________________________________________________
___________________________________________________

How Did You Find Out About This Class?
___________________________________________________
___________________________________________________
___________________________________________________

What Do You Wish To Accomplish Through This Class?
___________________________________________________
___________________________________________________
___________________________________________________

PRETRAINING AGREEMENT:
We, the undersigned, do hereby apply for training for our dog in the
designated class and agree:

- To follow and be bound by rules of the class
-To carry out the instructions given by the trainer(s)
-To devote additional time outside class to training
- To attend class regularly
- Agree to hold harmless as outlined below

AGREE TO HOLD HARMLESS, WAIVER AND ASSUMPTION OF RISK

I understand that attendance of a dog obedience training class is not risk
to myself, members of my family, or my dog because some of the dogs I may
be exposed to may be difficult to control and may be the cause of injury
even when handled with the greatest of care.

I hereby waive and release COMPANION DOG SCHOOL / PINEVIEW KENNELS /
HOWL A DAY INN / AMBERWAVES
any employees, officers, members and agents
from any and all liability of any nature, for injury or damage which I or my dog might suffer,
including specifically, but without limitation, any injury or damage from the action of my dog,
and I expressly assume the risk for such damage and injury while attending any
training session, or any other function of the training organization, or while on grounds or
surrounding area thereto.

In consideration of an inducement to the acceptance for training membership by this
training organization, I hereby agree to identify and hold harmless this training
organization, its employees, officers, members and agents from any and all claims
by any member of my family or any other person accompanying me to any training
session or function of the training organization 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 AGENT: ____________________________

DATE: ____ / _____ / ___________

DOG VETERINARIAN: __________________________

VET'S PHONE: _________________

DATE OF LAST:

DISTEMPER/PARVO: 1 yr 2yr 3yr (circle one)
RABIES: 1 yr 2yr 3yr (circle one)
BORDETELLA: ____________________

CLASS APPLYING FOR:

PUPPY / MIDDLE / BASIC / RALLY / GRADUATE

START DATE: _________________________________