Conformation Class Registration Form

Please fill in the form below.
Your Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Dog's Name
Dog's Breed
Dog's Date of Birth
Male or Female
Class Name*
List Dates of Vaccines (Distemper Combo, Rabies and Bordetella) *
Please bring proof of vaccines to first class for verification!
Name of Veterinarian*
Please add anything we should know about your dog.*
Please bring proof of vaccines to first class for verification!
I hereby release the Grand Island Kennel Club, its members, officers and board members from any and all liability of any nature for injury or damage which I or my dog may suffer, including specifically and without limitation, any injury resulting from the action of my dog and any piece of equipment and I expressly assume the risk of such damage while attending any training session or other function at the Grand Island Kennel Club, or while on the training grounds or surrounding area, or any other area where demonstrations may be held. me to training sessions or functions of the Club, or while on the grounds or the surrounding area, or any other area where demonstrations take place, as a result of any dog, including my own. CLASS FEES ARE NON-REFUNDABLE.
You must agree to register for classes, seminars and/or events.*

AGREE
My Products*
prevnext( X )
Non-Member Conformation Class Registration Fee (Required)$65.00

Member Conformation Class Registration Fee$35.00

Total $0.00
Should be Empty: