Specialty Series Registration Form: Cold Nose Canine, LLC

Specialty Series Class Registration Form
Cost is $40 per topic or $150 for all 4 topics.

Limited to 6 dogs • Payment is required to reserve your spot!

Name: *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

E-mail: *

example@example.com

Home/Cell Phone: *

Area Code Phone Number

Dog's Name: *

Breed/Mix: *

Dog's Age: *

Sex: *

Male Female

Spay/Neuter: *

Yes No

Referred by: *

Veterinarian's Name: *

Veterinarian's Phone: *

What topic/s are you registering for? (select all that apply) *

Topic 1: Start/Stop Behaviors Topic 2: Stationing Behaviors Topic 3: Syringes, Stethoscopes & Muzzles Topic 4: Road Trip to the Vet! (attendance at a minimum of 1 prior topic is required)

My main goal for class: *

Special concerns:

VACCINATION RECORDS: All dogs and puppies must be current on Distemper, Bordatella (Kennel Cough) and Rabies (if over 4 months of age) vaccinations and free of parasites to attend classes. Copy of records must accompany payment and be brought to first class.

RELEASE OF LIABILITY: As the legal owner of the dog listed on this registration form, I do hereby waive and release, Cold Nose Canine, LLC/Holly Lewis/agents/indpendent contractors/the facility from any and all liabilities of any nature. I agree to take complete responsibility for the actions of my dog, and myself, before, after, and during class. At no time will the instructor or assistant or facility of this class be liable or responsible for the actions of myself, my dog, or any other person who accompanies me to class. My dog is current on vaccines as required above. The owner of the dog(s) may have the animal withdrawn from training at any time, however, once training has begun; all fees are non-refundable.

I have read and agree to the release of liability verbiage: *

Yes No

Owner's Signature:

Clear

Today's Date: *

Month Day Year

Rabies Expiration: *

DHLPP Expiration: *

Bordatella Expiration: *

REGISTRATION DOES NOT GUARNATEE YOUR PARTICIPATION. We will contact you to confirm your participation and share payment remittance details at that time. Thank you!