GROUP TRAINING REGISTRATION APPLICATION

First Name

Last Name

Street Address

City

State/Province/Region

Zip/Postal Code

Phone Number

Work Phone

Email Address

Class Training Level

Name of Dog

Age of dog now?

Breed Type

Color

Neutered/Spayed

Yes

No

Sex

Male

Female

Is this your first dog?

Yes

No

Age of dog when acquired?

Have you ever attended obedience classes before? If so, what school or instructors?

Would you like to compete in obedience trials someday?

Yes

No

Possibly, tell me more

Please check other topics you are interested in learning more about, other than obedience

Do you use a crate?

Yes

No

Other

Do YOU or YOUR DOG have any physical limitations? Handicaps? Please explain

Please check all that apply

My dog has bitten someone

My dog has never bitten anyone

My dog has snapped at someone

My dog has Grabbed a human by the mouth

The bite broke the skin

Please explain

Agreement to hold harmless, waiver and assumption of risk:

In consideration of and as inducement to the acceptance of my application for training membership by Ann Savoy’s Country Kennels, hereinafter referred to as "Ann Savoy", I hereby waive and release "Ann Savoy", Her employees, members and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session, or any other function, of " Ann Savoy", or while on the training grounds or the surrounding area thereto.I hereby agree to indemnify and hold harmless "Ann Savoy", their employees, member and agents from any and all claims, or claims by any member of any family or any other persons accompanying me to any training sessions or functions of " Ann Savoy” or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

I agree to indemnify and hold “Ann Savoy” and, any of their contractors, agents or volunteers, harmless from and against 
all claims, losses, liabilities and damage to persons or property, governmental charges or fines and attorney's fees arising out 
of the acts or omissions of this class including, but not limited to: interactions with instructor(s), attendees, volunteers, and/or 
animals, screening or demonstrations involving my dog, or transportation of my dog to or from the class or within this same site.

I understand that I am responsible to carry Liability Insurance. 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 I will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of careFor the safety of other students and their dogs, instructors, and facility staff I understand that if my dog barks uncontrollably, is disturbing other people or pets, or shows aggression to any person or dog I may be asked to leave.“Ann Savoy” is not liable for any veterinarian bills that might occur during training. I am liable for any serious injury to “Ann Savoy”, Training Staff or Assistants.I have read and agree to the terms:

I have read and agree to the terms in the above Liability Waiver

Yes

No

Please contact your veterinarian for a printout of your dogs shot history. Bordetella, (Kennel Cough) is mandatory before starting class or using kennel service (all ages). Proof of Rabies is mandatory. Under 4 months, when they receive their shots and over 4 months, before the start of class. Any dogs without the required shot record printout will be excused before the start of the third class.

Payment for Group Classes. $95 for 6 weeks.

Name on Card

Credit Card Type

Credit Card Number

CSC Code

Expiration Date (mm/yy)

Please invoice me through paypal

Yes

No

Indicates Response Required