*Class Date/Time: Select Date/Time Thursdays, 5/29/08 - 7/3/08 (5:30 - 6:30 PM)

*Owner's Last Name:

*Owner's First Name:

*Names of other family members or guests attending class:

*Do you or family members have a disability we need to
know about (hearing/vision/mobility)?                                  

Address:             

City:                    

State:                  

Zip Code:            

Home Phone:      

Work Phone:       

Cell Phone:         

*Email Address:   

*Dog's Name:       

Breed:                  

*Age of dog on first day of class*: Yr.  Mo.  Wk.

Age of dog when acquired: Yr.  Mo.  Wk.

Weight of dog:       

Dog's sex:              Male    Female     

Spayed/Neutered:  Yes   No

Where did you get your dog?:

Name of Veterinarian:

Vaccine Expiration Dates (Mo/Day/Year): Rabies    DHPP

How did you hear about this class?:

Has your dog had prior training?: Yes No If so, where?:

Is you dog aggressive with people?: Yes No

*What are your goals for this class?

*Are there any other specific training issues?

Waiver, Assumption of Risk and Agreement To Hold Harmless

I understand that my attendance of a dog training session is not without risk to myself, my dog, any attending guests, family members and my personal property, because some of the dogs to which I will be exposed, as well as my own dog, may be difficult to control and may be the cause of injury or damage even when handled with the greatest amount of care.

In consideration of and as inducement of the acceptance of my application for training, I hereby waive and release TEAH ANDERS, GENTLE TOUCH PET TRAINING, 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 GENTLE TOUCH PET TRAINING, or while on the training grounds or the surrounding area thereto.

I also agree to defend, indemnify and to hold harmless TEAH ANDERS, GENTLE TOUCH PET TRAINING, from any and all claims, or claims by any member of my family or any other person accompanying me to any training session or function of GENTLE TOUCH PET TRAINING, or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own. I shall personally assume all responsibilities and liabilities for any loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of my dog participating in a GENTLE TOUCH PET TRAINING dog training session or while on the training grounds or the surrounding area thereto.

"My dog" in the above statements refers to any dog in my custody upon approaching the training grounds or adjacent areas.

Please indicate your acceptance of the terms and conditions by completing the name and date below:

*Name: /S                       *Date:

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