home schedule application email

Register Online!

ONLINE APPLICATION & WAIVER
Guardian's Name(s):
Dog's Name:
Dog's DOB or best estimate:
Breed:
Male / Female?
Spayed Neutered?
If yes at what age?
How did you obtain this dog?
How old was the dog when you brought him/her home?
Any other history on your dog that we should be aware of?
CLIENT INFORMATION
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email Address
Emergency Contact
Emergency Phone
Veterinarian
Vet Phone
Any Medical Conditions?
What type of training have you done in the past?
What type of socialization, if any, does your dog have with other dogs?
How did you hear about us?
Are you registering for?
IF YOU CHOOSE A GROUP CLASS:
Class Name:
Class Date:

Please send a copy of your current Rabies Certificate and proof of Distemper/Parvo and Kennel cough- if you choose to waive Kennel Cough- please send a note and sign it.

Agreement-

I hereby waive and release Anything Goes...for Dogs!! and Kym Jarvis from any and all liability to include injury to any person or dog, and damage caused by myself or my dog or dogs as a result of training my dogs under her guidance. If an incident of any kind would occur as result of my dog's participation in any activity whatsoever with Anything Goes...for Dogs!! or Kym Jarvis, I will assume full financial responsibility for any and all expenses involved including veterinary bills. I further understand and agree that Kym Jarvis will not be held liable for any problems that develop(i.e. Injuries, illness,fleas) provided reasonable care and precautions are followed. I understand and agree that my dog(s) is/are in good health. I agree to hold Anything Goes...for Dogs!! and Kym Jarvis harmless for claim(s) by any person(s) as a result of an action by any dog to include my own. If I have enrolled in group classes or any activity at any location other that my own home I fully understand the above statement applies to all management and staff at that facility.

 

Removal from Training-
I am aware that Kym Jarvis may remove my dog from any program if she feels that a threat or hazard of any nature is present. Further, I am aware that no refunds will be given as a result or such removal.

 

Payment-
I am aware that payment in full for any class or program is due upon registration prior to the first session and that no refunds or partial refunds will be given. I understand that if for any reason we must miss a class that no refunds will be given or makeup session scheduled- I am responsible for attending classes.

 

I Certify that I have read and understand this document:

I have received a copy of this document : (initials)

By printing your name below, this is acting as your signature.

Print name:

Date:

 

 

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