Type your information in the fields
below, then select the print option on your browser. Mail form, copy of
your dog's shot records and check payable to Susan Wise - 5625 Eden Roc Lane, NW
- Atlanta, GA 30342. Credit cards ARE NOT accepted for conformation
classes. Mark the class
start date on your calendar, no confirmations are mailed.
HANDLER INFORMATION
(one name only, co-owner may observe, please list age if under 18))
Name:
Address:
City/State/Zip:
Contact
Information:
(h)
(w)
(e-mail)
How did you
hear
about the classes?
Former Student
Current Student
Veterinarian
Brochure
Internet
If referred, please enter that person's name or internet source:
DOG INFORMATION
(copy of vaccination record for us to keep is required)
Dog's Name:
Breed:
DOB:
Sex: Dog
Bitch
Veterinarian's Name:
Last vaccination date:
CLICK on
CLASS REQUESTED BOX below (see
Schedule
page for next session starting date). 7pm - Beginner
8pm - Advanced
Session Beginning: ________________
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.
My signature below confirms that I agree with and accept the
conditions of the above disclaimer.