Keystone Canine Club Basic Obedience Enrollment Form

KEYSTONE CANINE CLUB - CLASS ENROLLMENT FORM

DOG OWNER INFORMATION
YOUR NAME:
ADDRESS:
CITY:	STATE:	ZIP:
DAY PHONE:	EVENING PHONE:
E-MAIL:
DOG HANDLER'S NAME (GIVE AGE, IF A MINOR):
PLEASE CHECK OFF HOW YOU HEARD ABOUT KCC: Radio ad ____ Pennysaver ____ Almanac ____ KCC website ____ Friend ____ Word-of-mouth ____ Attended previous KCC class ____ Other (how?) ______________________
DOG INFORMATION
DOG'S NAME:	DOG'S BREED:
DOG'S AGE:	SPAYED OR NEUTERED? Yes or No
DATE OF DOG'S VACCINATIONS:	DHLPP ____________	RABIES ___________
PLEASE BRING COPIES OF VACCINATION CERTIFICATES TO THE FIRST CLASS.
FOR PUPPY AND OBEDIENCE CLASSES, PLEASE CIRCLE ANY CONCERNS
HOUSEBREAKING	SHYNESS
PULLING ON LEASH	GROWLING
JUMPING ON PEOPLE	NIPS OR PLAY BITES
EXCESSIVE BARKING	AGGRESSIVE TOWARDS PEOPLE
PLAYING TOO ROUGH	AGGRESSIVE TOWARDS DOGS
CLASS INFORMATION
PLEASE ENTER THE NAME, DATE AND TIME OF THE CLASS THAT YOU WISH TO ATTEND. YOU WILL ONLY BE CONTACTED IF THERE IS A PROBLEM. SEE YOU IN CLASS!
CLASS NAME	START DATE	TIME

For information about preparing for your first class, visit our website (http://www.keystonecanine.com/kcc_class_hints.doc)

Your signature means that you accept the liability waiver and refund policy on page 2.

Signature: ________________________________________

Please mail this completed form and class payment ($55 for puppy kindergarten or $90 for other classes) to:
Keystone Canine Club, 2942 Industrial Boulevard, Bethel Park, PA 15102
info@keystonecanine.com
412-833-2211
Payments are non-refundable.

LIABILITY WAIVER

I hereby certify that the Keystone Canine Club (KCC), its events, and its staff, and any location or referring organization, and/or other participants, will not be liable for any damage or loss resulting from failure of my dog to respond to any signals, commands, or cues taught during the course of instruction or resulting from counseling, instruction, or advice supplied to me. My dog's behavior now and in the future is solely my responsibility. Should any behavior of my dog now or in the future result in damage to property, owner, or persons of some third party, I agree to assume full responsibility and liability to such third party for any and all such damage, and to indemnify and hold harmless KCC and its staff from all obligations to pay such damage to some third party. All dogs are trained by KCC without any liability whatsoever on KCC for loss or damage from disease, death, running away, theft, fire, injury to persons, other dogs, other animals, or property by said dog, or other unavoidable causes. In consideration of KCC permitting us to participate in KCC classes, and for other goods and valuable consideration, I hereby release, indemnify and forever hold harmless KCC from any liabilities, losses, costs, expenses, and damages or injuries whatsoever, which I or my dog may incur or sustain in connection with a KCC class. I also agree that any damage caused by my dog shall be my responsibility and not the responsibility of KCC.

REFUND POLICY

No refunds will be given unless classes are permanently cancelled by KCC. No refund will be give if the owner or handler misses or drops out of classes. No prorates will be given for missed class sessions. Rev 7-06-07