Action Canine Training Group Dog Training Class Registration

REGISTRATION FORM

Group Classes, Play & Train, Private Training, Stay & Train, Board & Train and Consultations
Name*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dog’s Name*
Male or Female*
Dog’s Birthdate (or approx age if birthdate is unknown)*
Breed or Mix (if unknown give your best guess)*
Does your dog have any history of dog or human aggression?*
Select a Class or Service*
Once the class is selected and form submitted we will contact you to confirm availability and send a payment link. If a service has been selected we will contact you to begin scheduling.
Veterinarian’s Name*
Upload your dog’s current vaccination record

Must be up to date on vaccinations. Or if in Puppy Prequel must be up to date for their age.
Cancelof
Liability Waiver
Your signature below shows you have read our liability waiver above and agree to same.
LIABILITY WAIVER

I understand that my participation in a dogobedience training class is not without risk to myself, my guests who may attend, and/or my dog, because some of the dogs to which we will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. Therefore, I hereby waive and release LAKE EMMA ANIMAL HOSPITAL and ACTION CANINE TRAINING LLC, its employees, officers, members, and agents from any liability of any nature, for injury or damage I and/or my dog may suffer, including specifically any injury or damage resulting from the actions of any dog; and I expressly assume the risk of such damages or injury while attending any training session, or any other function of ACTION CANINE TRAINING LLC or while on the training grounds at LAKE EMMA ANIMAL HOSPITAL or surrounding areas. In consideration of, and as inducement to, the acceptance of this application for obedience training by ACTION CANINE TRAINING LLC I hereby agree to indemnify and hold harmless ACTION CANINE TRAINING LLC and LAKE EMMA ANIMAL HOSPITAL, its employees, officers, members, and agents from any and all claims by me, my family or any other person accompanying me to any training session or function of ACTION CANINE TRAINING LLC & LAKE EMMA ANIMAL HOSPITAL, or while on the grounds or surrounding areas, as a result of any action by any dog, including my own. I hereby certify that the above dog has a current rabies vaccination and is up to date on all required vaccinations for this dogs age (if under 4 months old). I release ACTION CANINE TRAINING LLC and LAKE EMMA ANIMAL HOSPITAL from any and all injuries/damages inflicted on my dog and/or myself occurring during training periods on the premises. ACTION CANINE TRAINING LLC has my permission to take and use photographs, videos and/or other recordings of training activities involving Myself or my dog(s) for any lawful purpose without compensation. Once you click the submit button, your data will be sent to ACTION CANINE TRAINING LLC
By signing below I agree that I have read and understand the above liability waiver. *

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REGISTRATION FORM