Group Class, Workshop & Mini-Series Registration Form: Cold Nose Canine, LLC

Cold Nose Canine, LLC

Group Class, Workshop, and Mini-Session Registration Form
Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail:*
example@example.com
Home/Cell Phone:*

Area CodePhone Number
Dog's Name:*
Breed/Mix:*
Dog's Age:*
Sex:*

MaleFemale
Spay/Neuter:*

YesNo
Referred by:*
Veterinarian's Name:*
Veterinarian's Phone:*
Class Date:*
Class / Workshop Location:*

Pooch Palace (West Bend)Zoila's Zone/Aqua Therapups (Richfield)Don't Fret the Vet (Traveling Class)
How would you like to pay?*

Cash or CheckCredit Card (via PayPal)
Credit card payment (via PayPal) is required to reserve your spot in class. Please select your location to be charged the correct amount.*
prevnext( X )
Canine Foundations or Beyond Foundations at Pooch Palace (West Bend)$140.00

Canine Foundations at Zoila's Zone/Aqua Therapups (Richfield)$140.00

Mini-Session at Zoila's Zone/Aqua Therapups (Richfield) $75.00

Introduction to Nosework Workshop (Richfield)$60.00

Introduction to Nosework Workshop (West Bend)$60.00

Don't Fret the Vet (Traveling Class)$140.00

Total $0.00
My main goal for the class/workshop/mini-session:*
Special concerns:
VACCINATION RECORDS: All dogs and puppies must be current on Distemper, Bordatella (Kennel Cough) and Rabies (if over 4 months of age) vaccinations and free of parasites to attend classes. Copy of records must accompany payment and be brought to first class.
RELEASE OF LIABILITY: As the legal owner of the dog listed on this registration form, I do hereby waive and release, Cold Nose Canine, LLC/Holly Lewis/agents/indpendent contractors/the facility from any and all liabilities of any nature. I agree to take complete responsibility for the actions of my dog, and myself, before, after, and during class. At no time will the instructor or assistant or facility of this class be liable or responsible for the actions of myself, my dog, or any other person who accompanies me to class. My dog is current on vaccines as required above. The owner of the dog(s) may have the animal withdrawn from training at any time, however, once training has begun; all fees are non-refundable.
I have read and agree to the release of liability verbiage:*

YesNo
Owner's Signature:

Clear
Today's Date:*

MonthDayYear
Rabies Expiration:*
DHLPP Expiration:*
Bordatella Expiration:*
Should be Empty: