Owner Name *

First Name

Last Name

Phone *

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Owner Name *

First Name

Last Name

Phone #1 *

(###)

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Phone #2

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Vet Phone *

(###)

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Vaccinations *

Please mark the vaccines your dog has received. All dogs must have standard DAPP/DHPP (puppy/booster) shots to join class. Rabies shot is required for dogs over the age of 6 months. Bordetella vaccine is recommended but not required. Records can be emailed by vet or brought to first day of class.

DAPP/DHPP (puppy/booster)

Rabies

Bordetella

None

Waiver *

I (as signed above) do hereby waive and release Custom Canine Obedience, its officers, agent and employees, harmless from any and all liability or claims owner may have or that any other person or entity may have because of any death, bodily injury, personal injury, or because of any loss to property that may arise out of or in any way be connected with the dog’s training. Owner understands and agrees that, should owner fail to cooperate fully in following through with the training instructions, Custom Canine Obedience cannot and does not assume or accept responsibility for the behavior or performance of the dog after the dog leaves Custom Canine Obedience premises.

I accept.

I do not accept.

Today's Date *

MM

DD

YYYY