Print and Mail to:
Creekside Kennel
1629 Creekbank Lane Johns
Island SC 29455
Requested Class: Puppy
_______ Basic_________ Advanced __________
Agility________ Handling_____
Start date_________________________
Handler Information:
Name____________________________________
Address:________________________________
City:
Zip:___________
(H)Phone:____________________
(W)Phone:____________________
Cell
Phone_____________________
How did you
learn about these classes?
Former Trainee _______________________
Current Trainee ______________________
Telephone Book ___________________________
Veterinarian
________________________________
Newspaper ____________________________
Kennel ______________________
Other _____________________
Dog
Information:
Breed: __________________________
Call Name: __________________ Age:______
Male _______ Female_______
Veterinarian: ____________________________________________
Must have vet records!
Rabies, DHLPP, Bordetella (kennel cough) Required!
Briefly state what you hope to accomplish in this
class:
Has your dog ever exhibited aggressive behavior
towards people or other dogs?
Agreement to Hold
Harmless, Waiver and Assumption of Risk
I understand that attendance of a dog obedience
training class is not without risk to myself, members of my family or guests
who may attend, or my dog, because some dogs to which I will be exposed may be
difficult to control and may be the cause of injury even when handled with the
greatest amount of care.
I hereby waive and
release Creekside Kennel, hereinafter referred to as the "Training
Organization" its trainers, employees, officers, members, and agents from
any and all liability of any nature, for injury or damage which I or my dog may
suffer, including specialties, but without limitations, any injury or damage
resulting from the action of any dog, and I expressly assume the risk of such
damage or injury while attending and training session, or any other function,
of the Training Organization, or while on the training grounds of the
surrounding area thereto.
In consideration of and
as inducement to the acceptance of my application for training membership by
the Training Organization, I hereby agree to indemnify and hold harmless this
Training Organization, its employees, officers, members, and agents from any
other person accompanying me to any training session or function to the
Training Organization, or while on the grounds or surrounding area thereto as a
result of any action by any dog, including my own.
I certify the dog
entered in training or and other dog that I may have present, has been
immunized against rabies and DHLPPV, KC and is in good health.
_____________________________________________________
Signature of Owner or
authorized Agent (in case of a minor, a parent of legal guardian must sign)
Date: ________________