Registration Form
SouthPaw Training
17003 Cowan Rd
Alvin, TX 77511
Registration Form
Date: _____________2010
Projected Class Date:_________ Please check appropriate class All class payment Basic $150.00 ___ Confirmation $89 Mthly ___
Projected Class Date:_________ Please check appropriate class All class payment Basic $150.00 ___ Confirmation $89 Mthly ___ Due On/Or before Inter/Adv $125.00 ___ Graduate $200 Yearly___
The First class. Off Leash $125.00 ___ Focus $150 /6wk ___
$150 /6wk ___ Competition $90 Mthly___ Private $595.00 ____
Rally $54 Mthly___ Individual Plan _______ ____
Second Dog Discount_______ ___ Please Print Clearly (ask trainer for price)
(ask trainer for price)Your Name:_______________________________ E-Mail: ________________________________
Address: _______________________________________ Home Phone:______________________
City, State & Zip:__________________________ Cell or Bus. Phone:______________________
Breed of Dog:___________________________Age of Dog:____________Sex:_____________
Name of Dog:_______________________How long have you had this dog?_________________
Have you ever trained a dog before?___________When?___________Where?_______________
State briefly your reasons for training this dog.________________________________________
Name of your Veterinarian: ___________________________Phone # of Vet:______________
IF YOU DID NOT BRING YOUR INOCULATIONS. PLEASE BRING YOUR INOCULATION RECORD TO THE NEXT CLASS. ALL INOCULATIONS MUST BE UP TO DATE FOR YOUR DOG TO PARTICIPATE IN A SOUTHPAW TRAINING CLASS. (DHL, Parvo, Corona, Rabies)
From whom did you learn about these classes?
__________ Former Trainee __________ Groomer __________Advertising
__________Advertising__________ Current Trainee __________ Veterinarian __________ Other
__________ Other AS A CONDITION TO THE ACCEPTANCE OF REGISTRATION AT
SOUTHPAW TRAINING,
THE AGREEMENT BELOW
AND GUIDELINE AGGREEMENT MUST BE SIGNED.
SouthPaw Training
WAIVER, ASSUMPTION OF RISK AND
AGREEMENT TO HOLD HARMLESS
I understand that attendance in any dog training class is not without risk to me, members of my family or guests attending, or my dog. Some of the dogs which I (we) will be exposed may be difficult to control and may be the cause of injury, even when handled with the greatest amount of care.
I hereby waive and release the SouthPaw Training and/or Barbara Day, its officers, employees, owners, 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 the dog, and I expressly assume the risk of any such damage or injury while attending any training session or other function of the classes, or while on the training grounds or the surrounding area thereto.
In consideration of and as inducement to the acceptance of my application for dog training membership by this training facility: I hereby agree to indemnify and hold harmless this training facility, its Owners, officers, employees, members and agents from any and all claims or claims by any member of my family or any other person accompanying me to any training session or function of the school or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own or any person.
I also agree that I will not open or start any type of dog training business within a radius of 25 miles of SouthPaw Training/Barbara Day. If I am interested in opening up a dog training business I must notify SouthPaw Training/Barbara Day and request permission for the right to infringe on this area. The use of the SouthPaw Training Student book may not be used in any form, for any purpose, to be copied in part or whole or to be distributed for any purposes.
Signature of Owner or Authorized Agent:____________________________________________
(Parents must sign for minors)
Date of signing: _____________________
FOR OFFICE USE ONLY Please do not write in the space below
Class Fee:$____________________
Other: $____________________
Sub Total:$____________________
Deposit $ <________________>
Balance: $____________________
Check #: _______________
409-316-1777
Please Print the Pages below and you may Email them back to: southpawtraining@aol.com
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