ADOG/DTA - Obedience Class E-registration

HANDLER INFORMATION - THE PERSON WHO WILL BE HANDLING THE DOG IN CLASS MUST BE LISTED AND AGREE TO LIABILITY BELOW
(Co-owner/family members may observe, but only one person is allowed on the floor with the dog. Please enter age if handler is under 18.)

Handler First Name:

(R) Enter ONLY primary handler's name.

Handler Last Name:

(R) Age (if handler is under 18):

Street:

(R)

City:

(R) State: (R) Zip: (R)

Telephone Home:

(R) XXX-XXX-XXXX

Telephone Work/Cell:

(R) XXX-XXX-XXXX

E-mail:

(R)

Confirm E-mail:

(R) Re-enter your e-mail address.

Best Way to Reach You:

(R)

How did you hear
about us?

	Former Student	Current Student	Veterinarian
	Brochure	Internet	Other (list below)
Please enter student's name, internet source or other detail.

DOG INFORMATION

Call Name:

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Breed:

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Date of Birth:

(R)

Sex:

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Skills:

Tell us what your dog already knows (if anything) either from classes you've attended or that you've taught.

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Problems
Accomplish:

Tell us what problems you are having with your dog (we all have some) and what you want to accomplish in class.

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Veterinarian:

Name:	(R)
Telephone:	(R)

Vaccinations:

I hereby certify that my dog is current on all vaccinations and give my permission for ADOG to contact my veterinarian listed above to confirm.

(R)

RESCUE OR ANIMAL CONTROL INFORMATION (Use the Rescue the fee listed on the "Classes" page.)

Rescue Name:

Rescue E-mail/Web:

CLASS REQUESTED/SESSION/PAYMENT

Class Requested:

NOTE: Confirm class availability on Schedule page. If marked "FULL", select "Add to Waiting List" as your payment method and you will be contacted. Classes are held in the evening unless noted daytime (AM).
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Authorization Code:

NOTE: Classes marked with an asterisk (*) MUST have authorization, call 770-986-8317. Not required for Puppy, Pet Manners or Beginner (CGC).

Session Beginning Week:

(R)

NOTE: The date shown is the session starting date, see the Schedule page for specific class starting dates and times.

Payment Method:

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LIABILITY

Handler Release
From Liability:

RELEASE FROM LIABILITY - I hereby waive and release Atlanta’s Dogwood Obedience Group, LLC (“ADOG”) and Ambassador Corp, its employees, officers, members and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training class, or any other function while on the training grounds or the surrounding area. In consideration of and as inducement to the acceptance of my application for training membership by ADOG, I hereby agree to indemnify and hold harmless the above from any and all claims, or claims by any member of my family or any other person accompanying me to any of the training activities or other sponsored functions, or while on the facility or neighboring area thereto as a result of any action by any dog, including my own.

(R) I agree with and accept the conditions of the above disclaimer. By selecting "Agree", I confirm that it has the same effect of my personal signature agreeing to the conditions of the above disclaimer.

NOTE: After your registration is successfully transmitted, the Registration Confirmation page will open and you will select your payment method.