Dog Blessed Class Registration

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

How Did You Hear About Us?*

How Many Children Live In The Home?*

Have You Ever Owned A Dog?*

Have You Ever Trained A Dog?*

Briefly State What You Hope To Accomplish:*

Dog Information

Dog's Name*

Breed*

Age*

How Old Was The Dog When You Got It?*

Gender*

MaleFemale

How Long Has Dog Been living With You?*

Has Your Dog Been:*

SpayedNeuteredNone of the Above

Where Did You Acquire Your Dog?*

Is Your Dog House Trained?

Behavior Problems Of Parents Or Littermates, if Known?

Veterinarian

Dog's Diet*

Is Your Dog Current On Rabies Vaccine?*

YesNo

Medications Your Dog Is Currently Taking. Please Include Heartworm, Flea and Tick Medications, etc*

Please List Any Medical Problems Your Dog Has Had:*

Describe Any Previous Training:

Select All Items Dog DIslikes:

Describe Unwanted Behavior

Do You Use A Crate?*

YesNo

Does Your Dog Like The Crate?

YesNo

Do You Ever Muzzle Your Dog For Safety?*

YesNo

Is Anyone In Your Family Afraid Of Your Dog? If So, Please Describe:*

Has Your Dog Ever Bitten A Person?*

YesNo

AGREEMENT TO HOLD HARMLESS, WAIVER AND ASSUMPTION OF RISK

I hereby waive and release Dog Blessed LLC and locations of the training, hereinafter referred to as the "Training Organizations", its 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 specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session, or any other function, of the Training Organization, or while on the training grounds or the surrounding area thereto.

In consideration of and as inducement to the acceptance of my application for training, I hereby agree to indemnify and hold harmless this Dog Blessed LLC and Training Organizations, its employees, officers, members and agents from any and all claims, or claims by any member of any family or any other person accompanying me to any training session or function to the Training Organization, or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

I further agree to indemnify and hold harmless the Training Organizations if I would possibly contract COVID 19 or any other illness that the training or other event helps by the Training Organization.

Signature