Intro to Agility Registration Form

Student Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student E-mail*

example@example.com

Mobile Number*

Phone Number

Dog's name:*

Dog's breed:*

Dog's age:*

Dog's sex:*

FemaleFemale spayedMaleMale neutered

Where did you adopt/acquire your dog from:*

Is your dog current on Rabies (4 months and older); Distemper (DHPP); and Bordetella (Kennel Cough) vaccinations (required to attend class):*

Proof of vaccination is required to attend classes.

Does your dog have any aggression issues (will need instructor approval to attend class):*

Classes*

Intro to Agility: Saturday - 11:00am: August 26th (6 classes) (No classes September 9th, 23rd and October 7th) (Last class is October 28th)Intro to Agility: Saturday - 11:00am: November 4th (6 classes) (No classes November 18th, 25th and December 2nd, 23rd and 30th) (Last class is January 13th)

6 week class is $170
There will be no refunds, unless either a doctor's or veterinarian's note is provided, after two weeks before class is scheduled to begin

Liability Waiver:

I, the undersigned, confirm that I am the owner or person responsible for the dog(s) brought into Brandi Moore's (Manners & Moore Dog Training) classes and Spot-On Dog Training Center. I understand that Brandi Moore, Manners & Moore Dog Training, and Spot-On Dog Training Center are not responsible for any injuries or illnesses incurred by myself, my dependents, my guests or my dog(s) as a result of participation in this class and I waive and release any such claims resulting from participation in this class.

I understand that Brandi Moore, Manners & Moore Dog Training, and Spot-On Dog Training Center are not responsible for any damages caused by my dog(s) to persons, animals or to any property and are not responsible for any injuries or illnesses incurred by myself, my dependents, my guests or to my dog(s) as a result of participation in this class. I agree to indemnify and hold harmless Brandi Moore, Manners & Moore Dog Training, and Spot-On Dog Training Center and its owners and employees from any such claims.

I agree that payment in full is due at the time of registration. I understand that there will be no payment refunds, unless either a doctor's or veterinarian's note is provided, after two weeks before my class is scheduled to begin.

Signature (please use mouse to sign)*

Clear

Additional Comments

Classes*

Intro to Agility: Saturday - 11:00am: August 26th (No classes September 9th, 23rd and October 7th) (Last class is October 28th)6 classes

$170.00 Quantity
Item subtotal:$0.00

Intro to Agility: Saturday - 11:00am: November 4th (No classes November 18th, 25th and December 2nd, 23rd and 30th) (Last class is January 13th)6 classes

$170.00 Quantity
Item subtotal:$0.00

Total

$0.00

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Last Name

Credit Card Number

Security Code

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