Training Registration Form

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GREEN ACRES TRAINING CLASS REGISTRATION FORM

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Green Acres Training Class Registration Form for 2010
Name: ___________________________________________________________________________

(H)Phone: ___________________________ (W)Phone: ___________________________________

(C)Phone: ____________________________ Email: ______________________________________

Address: _________________________________________________________________________

City:_____________________________________________________ Zip: ____________________

Dog’s Name: _______________________________ Breed: ________________________________

Dog’s Date Of Birth: _____/_____/______ Sex:____________ Spayed/Neutered Color:__________

Veterinarian: ______________________________________________________________________

ü

CLASS (please check desired classes and record cost in EXT COST)

GA
CODE

START DATE
(1st Choice)

START DATE
(2nd Choice)

COST

EXT COST

SEMINAR - Intro to Dog Behavior & Clicker Training (included with Basic Manners)

T6

$55

INTRODUCTORY - Puppy Headstart (dogs under 16 weeks of age)

T9

$50

INTRODUCTORY – Basic Manners (dogs over 16 weeks of age)

T2

$125

INTRODUCTORY COMBO - Puppy Headstart & Basic Manners (Best Value!)

T9, T2

$160

& T17

Level 2 Workshop A: Out and About: Training the Advanced Recall and Heel/Walking Politely Behaviors

TL2B

$85

Level 2 – Workshop B:
Glad to See You: Training the Stay and Polite Greeting Behaviors

TL2C

$85

LEVL 3 – Canine Good Citizen Workshop

TL3

$60

TOTAL

$

Refunds for withdrawals from class must be requested at least 14 days prior to the first class.
Please do not forget to include your registration fee and shot records.
Remember to sign the waiver on the next page.

Credit Card# ____________________________________________ Exp. Date: ________________

Signature: _____________________________________________________________________

Office Use Only:

( ) Paid ( ) Training Database ( ) K9 Coordinator ( ) Confirmation Letter

Green Acres Waiver, Assumption of Risk and Agreement to Hold Harmless

I understand that attendance at a private or group dog training session 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 of care. In consideration of, and as an inducement to, the acceptance of my registration for a training session or sessions, I agree to indemnify and hold harmless, and hereby release Green Acres Kennel Shop, its employees, owners or agents from any and all liability of any nature, for injury or damage which I, my family or guests or my dog
may suffer, including specifically, but without limitation to, any injury or damage resulting from the action of any dog including my own, and I expressly assume the risk of any such damage or injury while attending any training session or other function of Green Acres Kennel Shop or while on property belonging to Green Acres Kennel Shop or at any other location where classes may be held.

I also understand that the degree to which a dog is successfully trained is a function of the interest, commitment, and cooperation of the owner. I acknowledge and agree that there is no guarantee that my dog will achieve the desired level of training despite the best efforts of the instructor.

I understand that I may withdraw from a class and receive a refund, minus a $15 handling fee, up until 14 days before my first class. After this time my registration fee becomes non-refundable. I also understand that after starting a class Green Acres staff may determine a group class is not suitable for my dog, in which case Green
Acres will credit the remainder of my class fees for private training or behavior counseling at their current rates.

I understand that photographs and video may be taken of me and my dog during classes and allow Green Acres to use those images in training and promotional materials.

All members of your family who will be handling your dog during training sessions must sign below.

Name _______________________________________________________________ Date _____/_____/_____

Signature _________________________________________________________________________________

Name _______________________________________________________________ Date _____/_____/_____

Signature _________________________________________________________________________________

Name _______________________________________________________________ Date _____/_____/_____

Signature _________________________________________________________________________________

Name _______________________________________________________________ Date _____/_____/_____

Signature _________________________________________________________________________________