CLASS REGISTRATION FORM

Name________________________________________________

Address______________________________________________

City, State, Zip_________________________________________

Phone (H)__________________ (W)_______________________

Age of Handler (if under 18)_____email______________________

Would you like to be added to our email list to receive announcements on upcoming sessions and events?_________

Dog's Name_______________________________Age_________

Breed____________________________________Sex_________

Has dog been to a previous class?___________________________

Which ones?____________________________________________

FIRST CHOICE Class____________________________________

Day/Time______________________________________________

SECOND CHOICE Class_________________________________

Day/Time______________________________________________

We would like to know your dog better so that we can make your class experience as rewarding as possible and address any problems you are having. Please check one box for each line.

Have you ever seen your dog:

Yes      No
____    ____  1. Chase a ball or frisbee
____    ____  2. Bark at a loud noise
____    ____  3. Off leash, follow you around the yard or house
____    ____  4. Growl at you when you tried to take away a special treat such as a rawhide
____    ____  5. Greet you enthusiastically when you returned home
____    ____  6. Get in the trash or garbage
____    ____  7. While in a car, bark or growl to a person outside the car
____    ____  8. Act very excited when you put on the leash
____    ____  9. Eat a treat in an unfamiliar place
____    ____  10. When away from home, bark, growl, or lunge at an unfamiliar person who approached
____    ____  11. Play with another dog
____    ____  12. When away from home, bark, growl, or snap at another dog
____    ____  13. Has your dog ever nipped or bitten a person?
If yes, please describe the circumstances:

____    ____  14. Has your dog ever nipped or bitten another dog?
If yes, please describe the circumstances:

Thank you for filling out this form. We look forward to meeting you and your dog at APS!

PLEASE READ AND SIGN.

I, the undersigned, in consideration of the enrollment for obedience training by the Animal Protection Society of Orange County, do hereby agree that I release and waive any right that I may have in law to recover medical payments, property damage, or bodily injury damages for any liability regardless of cost, provided that the liability is due to ordinary negligence (this release does not contemplate wanton, willful, or malicious conduct) as a result of any injury I may sustain from any other dog or my own dog, dogs, or any property belonging to me, within the class situation of the Animal Protection Society of Orange County.

I further agree that I hereby release and waive any right that I may have at law to hold the Animal Protection Society of Orange County and/or Board of Directors, employees, or volunteers liable for any injury that is due to ordinary circumstances of negligence.

I further agree that I am assuming the risk of participating in obedience training where there are other dogs whose temperament is unknown to me: that I assume full responsiblity for any injury that may occur to me, to my dog or dogs, or other property, or any damages that would ordinarily be due me, that I waive any right that I may have to institute any suit or other proceedings to recover therefore.

I have read this paper and am fully aware that this contract constitutes a waiver and release of any injury to me, my dog, dogs, or other property. I hereby certify that I am over 21 years of age, sober, and of sound state of mind.

Owner's Signature________________________________________

Date__________________________________________________