K-9 Charm Dog Training

804-694-0411

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Class Application

Last Name: ________________________ First Name: _______________________

Address: ___________________________ City , State , Zip :___________________

Home Phone: _______________________ Work:____________________________

Cell:_______________________________ Email:____________________________

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Name Of Dog's Handler:_____________________ Age If Under 18:_______________

Dog's Call Name:___________________________ Dog's Date Of Birth: ___________

Dog Breed:________________________________ Sex: ____ Spray__ Neuter ______

Formal Training: ___________________________ Does Dog Stay: IN____ OUT_____

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Class Dog Will Be Taking Amount of Payment: $_____________________

____ Basic Obedience Cash_____ Check___ Check #_______________

____ Advanced Basic Receipt #____________ By:___________________

____ Private Lesson Shot Record Checked: Dhlpp Exp. _______ Rabies______

____ Board/Train Vet. : __________________________________________

____ Show Handling Class Date:_____________________________________

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“ It is mutually agreed and understood that my liability is limited to the work performed on your pet. It is understood that I do not assume, nor do I accept, any responsibility or liability for the damage your pet may cause to people or to any property, and that I am to be 'held harmless' for any such action(s) caused by your pet.”

I have read the class requirements and I agree to abide by them. I understand that class fees are non-refundable. I accept complete responsibility for the actions of my dog(s) , and will not hold K-9 Charm Dog Training , or the owner of the training premises liable for any loss or injury to my dog or person.

Signature: ___________________________________ Date: ___________________

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Referred By: ____ Flyer's

___ Pet Shop- Name___________________ ____Friend

___ Vet- Vet's Name ___________________ ____ Other________________