OBEDIENCE CLASS REGISTRATION FORM
Donation Paid:____ Immunization Record:
Cash:___________ Parvo:____________
Check #_________ DHLP:____________ Adopted Dog?____ Instructor _______________ Bordetella:_________
Rabies____________
STARTING DATE OF CLASS____/____/201__
(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