ADOG/DTA - Private Lesson Information/Request

Review your information carefully before pressing "Submit Info". (R) = Required Information

HANDLER INFORMATION

First Name:

(R)

Last Name:

(R)

Street:

(R)

City/State/Zip:

(R)

Best Telephone:

(R) XXX-XXX-XXXX

E-mail:

(R)

Best Way to Reach You:

(R)

How did you
hear about us?

	Former Student	Current Student	Veterinarian
	Brochure	Search Engine	Other (list below)
Please enter referring student's name, search engine or other detail.

Lesson Details:

Private lessons are meant to cover your needs. I order to match you with the correct instructor, please tell us what problems you are currently having and what you would like to cover in your private lesson. Please be specific.

DOG INFORMATION

Call Name:

(R)

Breed:

(R)

Date of Birth:

(R)

Sex:

(R)

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)

DAY/TIME REQUESTED (We hold classes Monday through Thursday evenings so private lessons can not be scheduled for that time. Lessons can be scheduled during the day or on weekends only.)

What Days and Times are You Available for Your Lesson?

(R)

LIABILITY

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: Please click "Submit Request" only once. Clicking again will duplicate your request.