Owner's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Fully Vaccinated *

My dog has received all age appropriate vaccinations including (at a minimum): DHPP and Rabies and I will provide proof of vaccinations prior to the first class.

Fully Vaccinated

Not Fully Vaccinated

Classes desired: *

Which classes were you wanting to participate in?

S.T.A.R. Puppy

Basic Obedience

Regulations *

If accepted, I hereby agree to all the Training Class Regulations and I acknowledge reading the online copy of these regulations

Agree

Disagree

Liability *

I will, In the case of accident or injury in any way resulting from participation in classes, hold harmless from any liability therefore the LJKC and all officers, agents, members, thereof, and of all instructors, counselors, and persons in any way connected or associated with such classes

Agree

Disagree

Children *

I understand that any child under the age of 14 years will be accompanied by an adult who is NOT training another dog.

Agree

Disagree

Refunds *

I understand that there can be no refund of training fees

Agree

Disagree

Electronic Signature *

By signing and submitting this form I am agreeing to all of the above policies and regulations.

First Name

Last Name

Today's Date *

MM

DD

YYYY