Registration Form 413-387-4368 This registration form is for “Beginners Outdoor Agility.” Class will meet for approximately one hour a week for 4 weeks. Classes will meet at 570 Newton St South Hadley at 9:15 am and then travel to the practice location. Start date ______. Class Fee: $100. A deposit of $50 is required to have a spot held in the class. Name: _______________________________________________________ Address: ______________________________ City: __________________ State: __________ Zip Code: ____________ Email: __________________ Home Phone: (___)____________ Alternate Phone: (___)______________ Dog’s Name: ___________________ Breed: ________________________ Dog’s Age: _________ Sex: ________ Spayed/Neutered? No Yes Please provide proof of animal’s current vaccination history. Release of Liability I, (owners name)_____________________________, as the legal owner of (Dog’s name) ____________________ do hereby waive and release, Susanne Shaw of K9 Etiquette from any and all liabilities of any nature. I agree to take complete responsibility for the actions of my dog, and myself before, during, and after class. At no time will the instructor of this class or owner of this facility be liable or responsible for the actions of myself, my dog, or anyone who accompanies me to class. Owner’s Name: __________________________________ Date: ________ |