From: Subject: A Dog's Way Registration Form Date: Fri, 1 Sep 2006 21:46:41 -0400 MIME-Version: 1.0 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: file://C:\TPP\Website\ADW\ADW_Registration.htm X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2180 A Dog's Way = Registration Form

For=20 Office Use Only:

Course=20 Fee:________ Amount = Paid_________ Payment Method_____________ Date:_________

Comments:_____________________________________________________________=20

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Does=20 your dog have any disabilities that may challenge his or her = ability to=20 master the tasks included in this course? If so, please=20 explain.=20

 

Please=20 answer the following questions honestly. A Yes response will not = exclude=20 you from our services. We have experience working with aggression = and=20 other behavioral issues. Your responses will help us tailor our = program to=20 meet your specific needs.=20

Has=20 your dog ever growled at anyone (If so, please = explain.)?     = No    Yes=20

 

Has=20 your dog ever bitten anyone (If so, please explain.)?     = No     = Yes=20

 

Signature=20

Date=20

 Course:

 

Location:

 

 Date:

Time:

 

 

 

 

 

 

Last Name:

 

First Name:

 

 

 

Address:

 

 

 

 

 

City:

 

State:

 

Zip Code:

 

Phone (Home):

 

Phone (Work):

 

Phone (Other):

 

Email:=20

Best=20 way to reach you:=20

Best=20 time to reach you:=20

 

 

 

 

 

 

Dog=20 Name:

 

Breed:

 

Other:

 

DOB:

 

Gender:

 

Spayed/Neutered?

 

 

 

 

 

 

 

Do=20 you have any disabilities that may challenge your ability to = master the=20 tasks included in this course? If so, please explain. Please = include=20 requested accommodations.=20

Have=20 you taken other dog training course?     No   =  Yes=20

If=20 so, where?:=20

If=20 so, what courses have you taken?:=20

Have=20 you trained with us before?     = No    Yes=20

If=20 so, what courses have you taken?:=20

Informed=20 Consent: =

I=20 am aware and understand that there is always a risk involved when = working=20 with animals. There is always a risk of injury to me, my dog, and = any of=20 my guests. I am aware and understand that dogs may be difficult to = control=20 and that not all dogs will be under control at all times and may = cause=20 injury, even when handled with the greatest amount of care. I am = aware and=20 understand that I may be exposing my self and my dog and family = members to=20 other dogs that may cause injury and, conversely, that I will be = exposing=20 other persons and dogs to my dog, who may cause=20 injury.

I=20 here by voluntarily agree to indemnify and hold harmless A Dog=92s = Way, and=20 it=92s members, governors, managers, employees, hosting = facilities, and/or=20 agents, from and against any claims, demands, or actions, = including and=20 all costs and expenses, related to any injuries or damages which = are=20 alleges to have been caused by my dog.=20