Kennel Club of Greater Victoria Inc

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Dog's Name*

Dog's Breed*

Dog's Age*

Any Comments?

LIABILITY WAIVER: I understand that my attendance in class is not without risk to myself, my dog, other family members or guests, and other class participants (human or canine). These include, without limitation, risks of physical injury, mental injury, emotional distress, trauma, death, contact with other participants and their dogs, and property damage. All risks are known and appreciated by me. I waive any and all specific notice of the existence of the risks. I shall assume responsibility for and pay my and my dog's medical and emergency expenses in the event of injury, illness, or other incapacity regardless of whether I authorized such expenses.I agree that I, as owner of the above dog(s), am solely responsible for the dog(s) behavior and physical control and agree to carefully monitor and control it at all times.By reading, signing and dating this document, I hereby waive and release the Kennel Club of Greater Victoria, Inc., its officers and members, its volunteers and/or owners of any or all premises on which these classes are held, and/or its employees, agents and volunteers of said owners, from any and all damages, losses, fines, claims, suits, expenses (including attorney fees and defense costs), judgments and/or liabilities of any form or nature resulting from any act or omission of any dog or dog owner participating in the classes conducted under the auspices of the Kennel Club of Greater Victoria, Inc. This release of liability includes, but is not limited to any injury, death, sickness or personal injury or property damage my dog or I may suffer while on or around the premises where the instruction is held. This release also includes specifically, but without limitation, any and all forms of personal injury (including death and property damage to myself, other persons, and other animals resulting from the act or omissions of any and all dogs or dog owners and I expressly assume the risk of such damages or injuries and losses throughout the duration of the curriculumThis Agreement to Release and Waive Liability, Hold Harmless, Indemnify and Assume Risk of Injury or Loss shall survive the completion or termination of instruction services by the Kennel Club of Greater Victoria, Inc., their officers and members, and/or volunteers By my signature below, I hereby state that I fully understand and agree to the above terms and conditions in consideration for the instruction services provided by the Kennel Club of Greater Victoria, Inc and their officers, members or volunteers. Typing your name here constitutes a legal and binding signature*

First NameLast Name

Date Waiver Signed*

Date

Please Select

Conformation Class $40 + PayPal Fee $5$45.00

Total $0.00

Pay with PayPal

Please click one of the PayPal options to complete payment and submit the form.

Conformation Class Registration