Well-Mannered Dog - Group Class Registration

Home

tel: 203.264.2008
631.493.3471
email: Toni

In Connecticut serving:

Parts of Litchfield, New Haven, and Fairfield counties

Including:

Bethel, Bethlehem

Bridgewater, Brookfield

Danbury, Greenwich

Newtown, Norwalk

Oxford, Ridgefield

Roxbury, Sandy Hook

Washington, Woodbury

and surrounding areas

You are registering for:

The Well-Mannered Puppy Jumpstart,
Mon, 08/23/2010 at 6:45 PM - 8:45 PM

First Name
Last Name
Address
City
State
Zip
Email
Day Phone
Eve Phone
Dog's Name
Dog's Breed
Dog's Age
Dog is Spayed/Neutered?	Yes No
Dog's Sex	Male Female
Dog's Age when obtained
Where dog was purchased
Breeder's Name (if known)
Veterinarian/Clinic
Vet/Clinic Phone
Date of Last Inoculation
Bordatella vaccine?	Yes No
What are your specific goals?
Do you or your dog have any physical problem that might affect training? If so, please explain.
Has your dog ever tried to bite someone?	Yes No
Has your dog ever actually bitten someone?	Yes No
How did you hear about Toni Kay-Wolff and The Well-Mannered Dog?
I understand that attendance of a dog obedience training class is not without risk to myself, members of my family or guests who may attend, or my dog, because some of the dogs to which I (we) will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. I hereby waive and release The Well-Mannered Dog, Inc^®, its employees, owners, volunteers, and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the rist of any such damage or injury while attending any training session or other function of The Well-Mannered Dog, Inc^®, or while on the training grounds or the surrounding area thereto. In consideration of and as inducement to the acceptance of my application for training membership in this obedience training class, I hereby agree to indemnify and hold harmless The Well-Mannered Dog, Inc^®, its employees, owners and agents from all claims, or claims by any member of my family or any other person accompanying me to any training session or function of The Well-Mannered Dog, Inc^® or while on the grounds or surrounding area thereto as a result of any action by any dog, including my own.
I agree to the above Waiver of Liability.
Yes No

Thank you!