Canine
Companion
7 Spring Meadow Dr.
*
Application For Agility
Class
Name of
Owner: _______________________________
Address:
Phone:
(Home) _____________ (Cell)
___________________ (e-mail)
______________________
Name of
person training dog (handler): ______________________________
Dog's
Name: _______________________ Breed:
_____________________________
Dogs
Birth Date: _______________________ Sex: _______
Neutered/Spayed:___________
Class:________________________ Start Date:______________ Time:______________
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Please Answer The Following
Questions In Full
Has your
dog had any previous training ? ______
If so, where, by whom?
_______________________________________
Does
your dog bark, growl or lunge at people or other dogs? ______
If yes, when does this occur? __________________
____________________________________________________________________________________________________
Has Your
Dog Ever Attempted To Bite A Person?
______
Has Your
Dog Ever Attempted To Bite Another Dog?
_______
If you
answered yes to either of the last two questions, please use the reverse side
of this form to briefly describe the problem with the dog and give specific
examples of the dog's behavior. Dogs
that bark uncontrollably or that behave aggressively will not be allowed to
stay in class.
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Please Read and Sign:
I am aware that there are inherent
risks and hazards involved with dogs, and being around dogs, and in using and
being around dog agility equipment, I, agree to assume all risk of such
occurrences. The handler of the dog must
be physically able to control and work with the dog during class. Direct parental
supervision of children under the age of 16 is required during class
time. Children that disrupt the class
will not be allowed to attend.
Tuition must be paid in advance in
order to reserve a place in class. Refund
Policy: If for any reason you choose
to cancel your reservation, such a cancellation must be made at least three
working days prior to the start of the class.
No refund or credit of tuition
will be made after that time. Canine Companion reserves the right to remove
a handler and dog from class as the instructor deems necessary. Dogs that bark uncontrollably or that
behave aggressively will not be allowed to stay in class and no refund will be
given. If minimum class enrollment
is not reached prior to the start of class you will receive a refund or you may
transfer to another class. If you
would like to confirm the receipt of your registration please call me at
656-7664. No confirmation letters
are sent.
I hereby
release Canine Companion and its instructor and Traveling Tails Inn and the
owner(s) of the training area from any and all responsibility for accidents
caused either directly or indirectly by dogs or other conditions.
Signed:
_________________________________
Date: _____________________
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Vaccination
Date: Rabies _________DHPP __________
or date of titer ________Vet Clinic ____________________
Payment
Received: ________________
Check # or Cash:
____________________