Date ____________

If handler is under age 18, please state age:____. If handler is under age 15, this application must be approved by the Director of Training.

Address: _______________________________      City: __________________________________

State: _______Zip: ____________                            Email: ________________________________

Breeds trained? ________________________________

How did you hear of Fun In Dog Obedience? _____________________

Vet Clinic Name: ________________________________

Would you like the newsletter via hardcopy or on-line? If on-line, notice will be sent to above email address. (hardcopy/ on-line):______

Dog’s Name: _____________________________     Age: _________ Sex: __________

Breed(s) of this dog: __________________________   Dogs Date of Birth: ___________________________

Date & Time (5PM-8PM weekdays & Saturday 8AM-8PM): _______________________________________

In consideration of the acceptance of this application, I agree to hold harmless the Fun In Dog Obedience Training School, its members, and instructors, officers, agents, committees, employees and all persons connected or associated with the said school, and I do hereby release the same from any and all claims which I may have at any time, from the following: 1. Any loss or injury which may occur to any person or thing, and which may be caused directly or indirectly to any person or thing by an act of said above described dog while in or upon the premises or grounds, or in or near any entrance or exit thereto; it being my intention and agreement to assume full responsibility and liability therefore; 2. The disappearance or loss of said above named dog by theft, accident, death, or otherwise, and any damages or injury caused thereto by the negligence or carelessness of the school, its members or any person connected with said school in any manner, or by any other cause operating directly or indirectly while such person or such dogs are on the premises of the school.

I certify that the above described animal is not a wolf or a wolf hybrid.

Signed by: _______________________________________

(If the applicant is under 18 years of age, parent or guardian must sign this application; if over 18, the person handling the dog must sign.)

Date sent: ____________              Date Conf sent: ___________                  Date entered: _____________

Date Received: __________                      Rcvd By: _______________                     Method of Payment _______            Amt Pd: ________________