Intro to Agility Registration Form

Manners & Moore Dog Training - Intro to Agility Registration

Please fill out the form carefully for registration
Student Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / 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: *

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

Intro to Agility: Saturday - 11:00am: May 28th (6 weeks) (No classes on June 11th and July 9th)
- 6 week class is $155
- 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) *

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Additional Comments
Classes *
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Intro to Agility 6 week class
$ 155.00

Total

$ 0.00

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Manners & Moore Dog Training - Intro to Agility Registration