OBEDIENCE CLASS REGISTRATION FORM            

Donation Paid:____                                                                                        Immunization Record:

Cash:___________                                                                                        Parvo:____________

Check #_________                                                                                        DHLP:____________     Adopted Dog?____                         Instructor _______________                 Bordetella:_________

                                                                                                                      Rabies____________                                                                                    

                                      STARTING DATE OF CLASS____/____/200__               

                                                (Above For Office Use Only)

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                        CLASSES OFFERED    Puppies Must be 9 weeks To Attend Class

         (  ) Puppy (9 weeks-5mos)         (  ) Basic Refresher Obedience  (must complete Basic first)

         (  ) Basic Obedience                  (  ) Advance Obedience (progress to working off-lead) (Must 

                                                                 have completed Basic Plus)     

                                    INFORMATION ON PERSON TO BE TRAINING DOG*

(*PLEASE NOTE:  Only one handler for entire course.)

Name:______________________________________________________________________

Address:________________________City__________________State_______Zip__________

Phone #  (____)___- _______ Phone # to be reached at 5:00 P.M. if rainout. (____)___-________

Have you owned a dog before?  Yes_____ No_____

Have you trained a dog before Yes_____ No_____ If yes, where and when?__________________

What problem(s) brought you to this obedience training class, and what do you hope this training will accomplish?__________________________________________________________________

                                        INFORMATION ON DOG TO BE TRAINED

Dog’s call name:_____________Age:____ Sex: Male____ Female____ Neutered?___ Spayed?___

Breed:____________ If a mixed breed, please attempt a brief description____________________

Was dog adopted from: Humane Society?___S.P.C.A.?___501(c)3 Rescue?___Provide adoption contract.

Does dog or handler have any physical disabilities which may affect obedience training? Yes___No__ If yes describe________________________________________________________

In the last 6 months has dog had any illness or skin disorder? Yes____ No____ If yes, describe ______________________________________________________________________________

Was it treated by a veterinarian? Yes__No__ Veterinarian’s name/Clinic Name:________________

ARE ALL IMMUNIZATIONS CURRENT? YES___ NO___ Proof of Immunization must be presented with this form!

   “ALL PERSONS TRAINING A DOG MUST READ THE FOLLOWING AND SIGN BELOW”

NO REFUNDS GIVEN AFTER FIRST NIGHT OF TRAINING.   WeCare Dog Obedience,  It’s agents, members, instructors, assistant, county park etc., assume no responsibility for any loss, damage, illness, or injury sustained by the handler or any of their dogs, family spectators or property, or for injury to children present.

 

                         I HAVE READ AND UNDERSTAND THIS DISCLAIMER.

Signature of person training dog:_________________________________________________

          

                                       MAKE CHECKS PAYABLE TO: WCRR