DogTown Obedience Class Application for Courses Form

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516 Cote Hill Rd.     Morrisville, VT 05661     Phone: 802.224.6732
     E-Mail: dogtownobedience@myfairpoint.net      Web: www.dogtownobedience.com

Course Requested: ___ Beyond Basic Obedience (6 wks)          ___ Nov Comp Obedience (6 wks)           ___ Focus Class (6wks)       

. . . . . . . . . . . . . . ___ Beginner Agility (6 wks)            ___ Beginner Agility Part II (6 wks)                    

Course Start Date: (Please indicate first and second choices, as classes fill rapidly.)    

First Choice Start Date:           Day of Week    _____              Date     _____              Time     _____

Second Choice Start Date:       Day of Week    _____              Date     _____              Time     _____ 

Cost:          All 6 week courses are $100.   
Please include full payment or $25 deposit with application to reserve your spot.
Deposits are non-refundable. No refunds will be granted once your scheduled class has begun.

Name of Owner: _______________________________________ . Mailing Address: _______________________________________

Town: ______________________________State: ____  Zip: __________

Home Phone: ________________________ . . Work Phone: ____________________________

E-mail address: _____________________________________________________________________

Dog’s Name: __________________________  Breed(s) _____________________________

Dog’s Age: ______         Sex: ___  Male     ___ Neutered                                         ___ Female ___  Spayed

- How did you hear about our training program?   ________________________________________

-Vaccine Information:  All dogs must be vaccinated for Distemper, Parvo and Rabies. 
Puppies must be started on their Distemper/Parvo series to attend class.

***** Please include copy of Proof of Vaccinations or Current Titers with application and fees *****
OR    Bring copy with you to the first class.

Name of Animal Hospital:   ___________________________________________________

Date of last Distemper/Parvo vaccination (or titer): ___________________________

Date of last Rabies vaccination:  ______________________             1-year          3-year

WAIVER AND AGREEMENT TO HOLD HARMLESS
I understand that participation in DogTown Obedience Agility Classes, Obedience Classes, Private Lessons, Other Classes, Consults or Events is not without some risk, that despite all the dogs appearing healthy, and being handled with the greatest amount of care and foresight, dogs aren’t always predictable and the unexpected may occur. I hereby assume any and all risks that would customarily and ordinarily occur by my participation in dog handling, dog movement or activities on site, and waive and release to the benefit of DogTown Obedience in consideration for my acceptance and participation in the program. I hereby waive and release DogTown Obedience, its employees, owners and agents from any and all claims while on the grounds or surrounding area thereto, and resulting from participation in DogTown Obedience, including specifically, but without limitation, any injury or damage resulting from the action of any dog, including my own. I further agree to pay veterinary/medical expenses incurred as a result of injury caused by my dog(s).

      ______________________________________________    ____________________________
(Signature)                                                                                         (Date)