First Name:

Last Name:

Address:

Address 2:

City:

State/Province:

Zip Code:

Email Address:

Home Phone:

Cell Phone:

Your Dog's Name:

Your Dog's Breed:

Dog's Gender:

Your Dog's Birth Date:

Your Dog's Weight:

Expiration Date of your Dog's last Rabies Vaccination:

DHLPP Vaccination:

Kennel Cough (Bordatella) Vaccination:

Has your dog been treated by a veterinarian for an illness or injury in the past year?:

If yes, what was the diagnosis?:

If yes, what treatment was prescribed? (please describe):

Has your dog ever bitten a person?:

If Yes, please explain:

Has your dog ever bitten another dog?:

If Yes, please explain:

What class(es) have you already completed at The Doggie Den?:

What classes have you completed elsewhere?:

 

Please check any problems you are currently having with your dog

Barking:

Jumping Up:

Chewing:

HouseTraining:

Running Away:

Aggression:

Stealing Food:

Pulling on Leash:

Separation Anxiety:

Other:

Does your dog have any physical conditions, illnesses or limitations that might affect his/her training?:

If Yes, please explain:

What course are you registering for?

Puppy Kindergarden:

Beginner Obedience:

Intermediate Obedience:

Conformation Handling:

Course Date:

 

You must check "Yes I agree" in order to submit your registration.

 

Your registration will be complete when payment is received. 

When you click "submit" you will be returned to our training page where you can pay with a credit card through PayPal.  Thank You!

 

 

WAIVER, ASSUMPTION OF RISK AND AGREEMENT TO INDEMNIFY AND HOLD HARMLESS

 

I understand that attendance at a dog training class is not without risk to myself, members of my family or guests who may be on The Doggie Den premises, or to my dog, because some of the dogs to which I (we) may be exposed may be difficult to control and may be the cause of injury, even when supervised and handled with the greatest amount of care.

 

I hereby waive and release The Doggie Den, Inc, its employees, owners and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not limited to, any injury or damage resulting from the action of any dog; and I expressly assume the risk of any such damage or injury while on the premises of The Doggie Den or in the surrounding area.

 

In consideration of and as inducement to the acceptance of my application for participation in a dog training class, I hereby agree to indemnify and hold harmless The Doggie Den, Inc, its employees, owners and agents from any and all claims, or claims by any member of my family or any other person accompanying my dog on The Doggie Den premises or in the surrounding area as a result of any action by any dog, including my own.

 

I understand that there are no refunds once my class begins.

 

Yes, I Agree to the Waiver Above