20 __ Results Puppy & Dog Training - Pawformance Dog Sports
Trainer Information, Rules & Waiver
NEW? Bring a copy of your pet's health record for my file and this completed two page form to your first class. No printer? Blank forms are available at class, arrive 15 min. early to complete.
Brighton Community Ed (BCE) and the Howell Parks and Recreation Authority (HP&RA) each have a 'no refund policy'. Before paying to hold a spot, follow #1 - #6 at the Results Schedule page to help ensure a good fit for your pet. For general information: Results Puppy & Dog Training Home Page
Owner-Trainer Name: Pet Name & Birthdate:
Street Address: Breed(s):
City: Zip: Male Neutered - Y N
Phone(s): Female Spayed - Y N
Referred by: Vet. Clinic:
Length of ownership: Acquired from:
Use the back of the form if more room is needed for the Q.'s below.
Household Members & Other Pets:
Emergency Contact & Phone / Health Alert for people or pet? If yes - explain
Have you attended a class with this and/or other dogs? If yes, when and where?
List what pet knows: Term or command, teaching method(s) and equipment used.
Describe your pets' temperament.
Has your dog ever shown aggression? NO YES If yes, please explain.
List your goals and help desired.
Class Name Brighton or Howell Start End Time Fee
AGREEMENT TO HOLD-HARMLESS WAIVER AND ASSUMPTION OF RISK: I, the undersigned participant, hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assign to: (A) waive, release, and discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including as to my traveling to and from any events or while training at my home, the following entities or persons: Results Dog Training, Mary T. Ratelle, her employees, volunteers, representatives and agents and others working or acting on her behalf, and to the extent permitted by law (B) indemnify and hold harmless the entities or persons mentioned in the paragraph from any and all liabilities or claims made by other individuals or entities as a result of or relating to my attendance at or participation in any events or lessons by Mary T. Ratelle, her volunteers and guests and assume all responsibility for my, any person(s) in attendance with me and my canines participation. I hereby certify that I and my canine are physically fit for participation in events and lessons. I have read this document and understand its contents and the conditions of training with Mary T. Ratelle, Results Puppy & Dog Training and/or Pawformance Dog Sports including but not limited to all locations noted and I will comply.
TRAINER (you)____________________________________ DATE OF BIRTH________________
Driver License #________________________________________ Phone(s):
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