Dog Class Training Registration Form (PayPal or Check Payment ONLY)

Fall 2024 Dog Training Class: Enrollment Application

Obedience Training Club of Bartlesville
** THIS ENROLLMENT FORM IS FOR PAYPAL OR CHECK PAYMENT ONLY!!! **

Fall Classes begin September 10, 2024 and end October 29, 2024; enrollment closes September 3, 2024 or when classes fill. Classes meet for eight (8) one-hour sessions on Tuesdays. Classes meet at: Washington County Fairgrounds, Dewey, Oklahoma, 74029. (Parking and entry for class is at back.) Children must be 12 years of age or older to participate. COVID PRECAUTIONS MAY APPLY – IF THE BARTLESVILLE PUBLIC SCHOOLS LOCAL CASE LEVEL IS ABOVE “YELLOW”, MASKS WILL BE REQUIRED WHILE IN THE BUILDING, WE WILL SOCIAL-DISTANCE CLASS MEMBERS, AND NO VISITORS WILL BE ALLOWED.

Please complete all fields below and submit form. Fields with * are required.
Full Name*

First NameLast Name
Call Name of Your Dog*
Dog's Name
E-mail (confirmations/lessons will be emailed)*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age if under 18 (minimum 12)
Parent/guardian required to be present at classes
Neck Size for Collar (inches) - beginner class only
Use string to circle neck, then measure string
Dog's Breed*
Dog's Breed
Birthdate of Dog (best estimate ok)*

MonthDayYear
Birthdate of Dog
Veterinarian*
Veterinarian
Approximate Height/Weight of Dog*

Height / inchesWeight / lbs
Date of Last Vaccinations*

DHPPRabiesBordatella (Kennel Cough) - Recommended after 3/10/24; MUST be after 9/10/23
Upload a Copy of Current Vaccination Records Here

Browse Files
Current Vaccination Records from Veterinarian Cancelof
Class to Attend (may enroll in more than one)*

KPT 5:00PM (dog's birthdate must be after 3/10/24)KPT 6:15PM (dog's birthdate must be after 3/10/24)Large Dog Beginners 6:15PMSmall Dog Beginners 7:30PMIntermediate Obedience 8:30PMNosework 6:15PMTrick Class 6:15PMAgility 1 7:30PMAgility 2-3 8:30PMNovice Review/Intermediate Rally Class 5:00PMNovice Rally Class 7:30PM
What specific problems are you having? (check all that apply)

House Soils/AccidentsJumping UpDigsRuns Away/Will Not Come When CalledChewsBarksUnrulyShy/Under-SocializedPlay Bites/Plays RoughAgressive (Other Dogs/People)Other
What do you hope to accomplish with training?
Have you trained a dog before? If so, where?
How did you find out about OTCB?

FacebookOTCB WebsiteNewspaperOther
WAIVER, ASSUMPTION OF RISK AND AGREEMENT TO HOLD HARMLESS

I understand that attendance of a dog obedience training class is not without risk to myself, members of my family or guests who may attend, 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 care. I understand that there is a risk of exposure to or contraction of COVID while participating. If notified by OTCB that it is required, I do agree to wear a mask over my nose and mouth while in the building, and to keep a distance of 6 feet from other people while in the building. I hereby waive and release Obedience Training Club of Bartlesville, Inc., its employees, officers, members and agents of any liability of any nature, for injury or damage which I, those who accompany me, or my dog may suffer, including, specifically, but without limitation, any injury or damage resulting from the action of any person or any dog, or from exposure to or contraction of COVID-19, and I expressly assume the risk of such damage or injury while attending any training session or other function of the Obedience Training Club of Bartlesville, Inc., or while on the grounds or the surrounding area thereto. In consideration of and as inducement to the acceptance of my application for training in this obedience class, I hereby agree to indemnify and hold harmless Obedience Training Club of Bartlesville, Inc. its employees, officers, members and agents from any and all claims, or claims by any member of my family or any other persons accompanying me to any training session or function of the Obedience Training Club of Bartlesville, Inc., or while on the grounds or the surrounding area as a result of any action by any person or by dog, including my own.
Optional

I do NOT consent to use of my photograph/video on OTCB publications
Signature*

Powered by Jotform SignClear
Sign by using a touch tablet/screen or left click and hold as you sign with your mouse.
SIGN ME UP!

Click the Submit button below to submit your online application to the OTCB Training Director.

Paypal is available using: paypal.me/OTCBville

If not paying electronically using payment method options above, payment may be made by check payable to OTCB. Mail check to: OTCB, P.O. Box 487, Bartlesville, OK 74005.

**You must provide a copy of your current vaccination records before you will be enrolled! Use one of these options: 1) upload above using this form; 2) email a scan or picture of current vaccination records to k9otcb@gmail.com; or, 3) mail a copy to OTCB, P.O. Box 487, Bartlesville, OK 74005.

Once your application and vaccination records are received, please allow up to 48 hours for a response with confirmation of your place in class and further instructions. Final confirmation will be sent with lesson plans via email the week prior to the start of classes.

Questions? Call (918) 641-4010 or send us an email at k9otcb@gmail.com.
After you successfully click Submit below, you will receive a confirmation page showing all your entries. If the Submit button is not advancing to the confirmation page, PLEASE SCROLL UP AND CHECK THAT ALL REQUIRED FIELDS ARE POPULATED. Thank you!
Should be Empty:

Fall 2024 Dog Training Class: Enrollment Application