2019-01-16 MVDTC FINAL

MOUNT VERNON DOG TRAINING CLUB, INC.

Date*

Date

Owner's Name*

Street Address*

City*

State*

Zip*

Home Phone

Cell Phone*

E Mail Address*

example@example.com

Breed(s)*

Call Name(s)*

Age*

Dog 2

Breed(s)

Call Name(s)

Age

I certify my dog(s), listed above, were vaccinated against rabies by Dr _____ (telephone Number)_________on Date __/___/__(MM/DD/YY) and expires on Date __/__/__ (MM/DD/YY)*

Veterinarian Name

Phone Number*

Vet Phone number. Please enter a valid phone number.

Date*

Date Rabies was given

Date*

Date Rabies Expires

I also certify that I am following the recommendations of my veterinarian(s) to assure my dog(s) are free of internal and external parasites, any communicable diseases, and have appropriate vaccinations. In addition,I certify that I will continue to maintain a current rabies vaccination at all times and follow the recommendations of my veterinarian(s) as long as I am participating in activities and classes with Mount Vernon Dog Training Club, Inc.

Signature*

Date*

Date

MOUNT VERNON DOG TRAINING CLUB, INC.

1. Dog(s) must be on leash*;

2. Participant(s) must maintain control of their dog(s);

3. Dog(s) will not be left unattended in class;

4. Participant(s) must leave appropriate room between their dog(s) and other dogs in the class;

5. Dog(s) will have the appropriate collar for class (a flat buckle collar, training collar,or martingale Prong collars, e-collars, harnesses or head collars are not permitted;

6. Participant(s) will wear appropriate footwear to class (i.e. gym shoes Flip-flops, slippers, and clogs are not permitted;

7. Dog(s) and Instructor(s) must be treated with respect;

8. Participant(s) must abide by the facility's rules where the class is being held and any future rules promulgated by Mount Vernon Dog Training Club, Inc. or its instructors; and

9.Some classes and programs are not appropriate for all dogs. MVDTC reserves the right to remove or refuse a dog from any class or program.

"Under limited circumstances the instructor(s) may ask the participant(s) to unleash their dog for certain exercises in class. It is the responsibility of the participant(s) to continue to maintain control under these limited circumstances.

Failure to comply with the above rules and regulations may lead to removal from the class or program. Refunds for classes or programs will be reviewed on a case-by-case basis by the instructor(s) and treasurer.

I certify that I have been given, read, understand, and will comply with the Rules and Regulations of Mount Vernon Dog Training Club, Inc. ("MVDTC" As a material inducement to permit my dog to be trained with MVDTC, I voluntarily release MVDTC from claims, as stated more fully on the MVDTC Release signed by me.

(Participant, and/or Parent or legal guardian if a Minor)*

Date*

Date

MOUNT VERNON DOG TRAINING CLUB, INC.

MOUNT VERNON DOG TRAINING CLUB, INC. RELEASE AND WAIVER

I understand that there are known inherent risks and unknown unanticipated risks associated with training, socializing, and working with dogs in general, including any incidental walking associated with training. I assume any and all risk and responsibility for myself and my dog(s) during training, walking and any other work with Mount Vernon Dog Training Club, Inc. ("MVDTC"), assuming ordinary care has been exercised. I will not hold MVDTC, its agents, owners, officers, instructors, volunteers, participants, employees, and all other persons or entities acting in any capacity on its behalf responsible for any injuries or misfortunes (to or by me or my dog) while training, or any other work with MVDTC, should they occur. I further understand that due to the way that dogs interact with one another, cuts or scratches can occur to me or my dog, even though the dogs are carefully supervised. I also understand that my participation in any of these activities is not without risks and can resultin physical harm to myself or my dog(s).

I hereby release and agree to and hold harmless MVDTC, its agents, owners, officers, instructors, volunteers, participants, employees, and all other persons or entities acting in any capacity on its behalf from any and all liability, claims, suits, actions, loss, injury or damage of any nature or kind, or for any liability, claims, suits, actions, loss, injury, damage, or legal fee(s), which I or my dog(s) may sustain or which may be caused in any way by myself or my dog(s I specifically, without limitation, agree to fully indemnify MVDTC, its employees and/or agents for any and all such liability, claims, suits, actions, losses, injury, damage and legal fee(s I understand that I am solely financially responsible for any damage or harm caused by my dog during training, socializing, and working with dogs in general, including any incidental walking associated with training.

I take it upon myself to ask questions and use my own common sense. I understand that I do not have to do anything or allow anything to be done that I do not feel comfortable with.

By signing the below I, my heirs, executors, administrators, and assigns, acknowledge that I have fully read and understand the provisions above hereby agree to release and hold harmless MVDTC. and their respective officers, directors, employees, instructors, volunteers, agents, members including the instructors teaching their dog training classes and all other persons or entities acting in any capacity on its behalf from any actions, suits, claims, losses and demands of any kind, which I, my heirs, executors, administrators and assigns had, now have, or hereafter may have by reason of any matter arising from or in connection with my participation in this dog training class, including without limitation any injury, accidental death or damage to person, property, or dog(s By signing this document, I also acknowledge that if anyone is hurt or property is damaged during my participation in activities at MVDTC, I may be found by a court of law to have waived my right to maintain a lawsuit against MVDTC on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document,understood it, and I agree to be bound by its terms.

NOTICE TO THE MINOR CHILD'S NATURAL GUARDIAN: READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF MVDTC USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD'S RIGHT AND YOUR RIGHT TO RECOVER AGAINST MVDTC IN A LAWSUIT FOR ANY DAMAGES, INCLUDING PERSONAL INJURY,, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE MOUNT VERNON DOG TRAINING CLUB, INC.

ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND MVDTC HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

In addition to the terms, conditions, and acknowledgments contained above, and in consideration of the minor being permitted by MVDTC to participate in its activities and to use its equipment and facilities, I further agree to perpetually release, indemnify, and hold harmless MVDTC, its agents, owners, officers, instructors, volunteers, participants, employees, and all other persons or entities acting in any capacity on its behalf from any and all claims which are brought by, or on behalf of the minor, and are in any way connected to minor's use of MVDTC's premises, or participation in MVDTC activities, including any such claims caused by, or alleged to be caused by, negligent acts or omissions of MVDTC. If the Participant is under 18 years old, I, the undersign, represent and affirm that I am the parent or legal guardian ofthe Participant, and I do hereby consent and give my permission to all the provisions of this release on behalf of the Participant.

This Release shall be governed and conformed in accordance with the laws of the Commonwealth of Virginia without regard to its conflict of laws provisions.

THE PARTIES HEREBY IRREVOCABLY SUBMIT TO THE JURISDICTION OF THE FEDERAL AND STATE COURTS IN ALEXANDRIA, VIRGINIA, AND AGREE THAT ANY ACTION, SUIT OR PROCEEDING CONCERNING, RELATED TO OR ARISING OUT OF THIS AGREEMENT SHALL BE HEARD AND DETERMINED IN THE FEDERAL AND STATE COURTS IN ALEXANDRIA, VIRGINIA, AND FURTHER IRREVOCABLY WAIVE ANY OBJECTION WHICH THEY MAY NOW OR HEREAFTER HAVE TO THE LAYING OF VENUE OF ANY SUCH DISPUTE BROUGHT IN SUCH COURT OR ANY DEFENSE OF INCONVENIENT FORUM FOR THE MAINTENANCE OF SUCH DISPUTE. BOTH PARTIES AGREE TO WAIVE TRIAL BY JURY FOR ALL CLAIMS ARISING PURSUANT TO THIS AGREEMENT.

Minor's name (if applicable)

Signature*

(Participant, and/or Parent or legal guardian if a Minor)

Date*

Date