Diabetic Alert Dog Summit Spring 2020

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First Name Last Name

Address

Street Address

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Postal / Zip Code

E-mail

Phone Number

Area Code Phone Number

Do you have any dietary restrictions?

Yes No

If Yes please explain so that we can ensure we have suitable lunches prepared for you.

Will you be needing a ride to and from the airport?

Yes No

What do you hope to accomplish during this week with us?

Payments are refundable for up to 72 hours from the time of sale unless purchase was made on or after October 15th, 2019. All sales after October 15th, 2019 are final. This is a secure payment portal and we do not receive any of your payment information. If you prefer to make a payment over the phone you may do so by calling (817) 668-5867. There is a 3% fee for all payments taken over the phone. If you are unable to pay the full amount, but wish to reserve a spot and make payments please call or email as soon as you fill out this form. Thank you

USD Diabetic Alert Dog 6 Day Course

Credit Card

Personal Release of Liability.Each participant must sign the forms attached IN CONSIDERATION of being able to participate in the entitled activities of Top Dog Professional Training,the undersigned: 1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Daycare/Trainingprovider, promoter, other participants, owners and lessees of the premises used to conduct the Top DogPrograms and each of them, or their agents and employees, all for the purpose herein referred to as“Releasees,” from all liability to the undersigned for any and all loss or damage and any claim or demandstherefor on account of injury to the person or property or resulting in the death of the person or propertyof the undersigned arising out of or relating to training or daycare activities, whether caused by thenegligence of the Releasees or not. 2. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them fromany loss, liability, damage or cost they may incur arising out of or related to training or daycare activitieswhether caused by the negligence of the Releasees or otherwise. 3. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTYDAMAGE, INCLUDING DEATH, arising out of or related to training and daycare activities whether caused bythe negligence of Releasees or otherwise. 4. HEREBY ACKNOWLEDGES THAT THE ACTIVITIES OF TRAINING AND DAYCARE MAY BE DANGEROUS.TRAINING AND DAYCARE ACTIVITIES involve the risk of serious injury and/or death and/or damage topersons or property. These programs involve participation of working animals that may be subject todemanding physical and sometimes harsh climactic conditions. 5. HEREBY AGREES THAT THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK ANDINDEMNITY AGREEMENT EXTENDS to all acts of negligence by the Releasees and is intended to be asbroad and inclusive as is permitted by the laws of the State of Texas, or other states where training ordoggy daycare is conducted by the releasees and that if any portion thereof is held invalid, it is agreed thatthe balance shall, notwithstanding, continue in full legal force and effect. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITYAGREEMENT, FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIALRIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT,ASSURANCE OR GUARANTEE BEING MADE TO ME. I INTEND MY SIGNATURE TO BE A COMPLETE ANDUNCONDITIONAL RELASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

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