New Student Application 2024

New Student Application

I will be in touch via email soon after I receive this.

Your Name*

First NameLast Name

Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

Mobile Phone Number*

Dog's Name*

Dog's Age?

Breed or type of Mix*

Do you have any dog training experience at all (even a PetsMart class counts)*

YesNo

If yes, please describe any other classes taken or experience.

What trained behaviors does your dog know (if any)?*

Have you ever competed in any type of canine competition? If so, what type of event(s) and have you earned any titles?

Describe your dog's personality in a few words. i.e. Happy go lucky, fearful of strangers, likes to play with toys, not good with other dogs, etc.

Has your dog ever bitten a person or other dog? If so, please explain circumstances.*

Is your dog kept behind an electric fence?*

YesNo

Has your dog ever or is your dog currently being trained with a shock collar?*

YesNo

If shock collar training has been used, please explain circumstances

COVID 19 ISSUES

Have you had the COVID vaccine? I*

YesNo

Are you willing to wear a face mask if we are in another covid surge while training at Creekside Canines?*

YesNo

REFUND POLICY: Your evaluation fee is NOT REFUNDABLE unless I decide that Creekside is not the appropriate training facility for your dog. If you are a no show without 24 hours notice, the credit card you entered will be charged the full amount.

WAIVER OF LIABILITY: I have read and agree to the Release of Liability as stated below.

Refund & Liability Waiver*

By checking this box, I have read and agreed to the refund policy and waiver of liability.

Creekside Canines Release of Liability

In consideration for being allowed to participate and/or observe in training classes, on

Creekside Canines premises located at 9016 Larchwood Dr, Kernersville, NC, (hereinafter referred to as “the Premises”), the undersigned does hereby fully understand the following:

Undersigned acknowledges that the Premises and the animals, guests, items and activities thereon, pose dangers to people and animals. Such dangers include, by way of example and not limitation; animals that can bite, trip, knock down, and fight, indoor and outdoor surfaces that may be slippery, equipment that can trip, persons who cannot control their dogs, and activities involving dogs that can result in injury from bites or other causes. Accordingly, Undersigned, on behalf of him/her, his/her spouse and minor children, and anyone else whom Undersigned brings onto the Premises of the Owner or Occupier, (a) waives any and all legal duties on the part of the Owner or Occupier to keep the Premises free of dangers and defects, and to warn of any of the same, and (b) releases Owner or Occupier from and assumes the risk of injuries, losses, damages, costs and expenses by any means above described, and other injuries, losses, damages, costs and expenses of every possible cause and description unless inflicted intentionally or recklessly by the agents and employees of Owner or Occupier.

2. I further release and acquit Lynn Brodie, Creekside Canines and all other persons for any liability for medical or veterinary expenses that may be the result of any accident that may occur to me, my child or my animal.

3. I expressly understand this to mean that I am relinquishing and releasing my right to sue others in either negligence of for strict liability based on either another person’s act or the actions of their animal.

4. I hereby declare that I am of legal age and competent to sign this agreement and that if not, that my parent or legal guardian is in complete understanding and concurrence with this agreement. I understand this agreement. I agree to be bound by it.

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