Agility Classes at Dog Works Canine Form and Function – Holbrook, LI, NY Monday Daytime Winter/Spring 2008

Check box to select class(s) you are joining:

Intermediate  9:30-10:30 □    Competition 10:45-11:45 □      Novice 12:00-1:00 □      Novice  1:15-2:15  □

Beginner 2:30-3:30  □    (new Beginner students, please wait outside until the 1:15 class is complete and they have left the room before you come into the facility.  Please leave your dogs in the car until we finish the paperwork, class will start up after that)

Class fee: $100 for the six week session.

Name:__________________________________________________________________________

Address_________________________________________________________________________

City______________________________________ State_________________ Zip______________ 

Telephone____________________ E-mail______________________________________________

Dogs Name_____________________________ Breed______________________ Age__________

Payment enclosed___________________________ amount.

Handler Emergency Contact_______________________________Telephone #___________________

Dog Emergency Contact__________________________________Telephone #___________________

Write your complete mailing address, telephone number and email address on application form. 

Please make checks payable to Louise Wetzel. Mail payment with this form and please include the signed indemnification portion to: 

Louise Wetzel

79-78 78 Avenue

Glendale, NY 11385           516-220-3727  www.dragonfireagility.com     E-mail:  dragondogs4@nyc.rr.com

INDEMNIFICATION 

                        I understand that attendance at dog agility training class is not without risk to myself, members of my family and/or guests who may attend, or to my dogs.  Some of the dogs to which I will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest of care.  I understand that agility obstacles by their very nature present a potential danger for dogs and/or handlers, notwithstanding care taken to insure safety.  I have examined the training facility and the surrounding area and accept all risks associated with working with my dog in this facility.  I hereby release and hold harmless [Dog Works Canine Form and Function], its officers, members, instructors and students from any and all liability of any nature, including, but not limited to, any injury or damage which I, my family members and/or guests, or my dog(s) may suffer while attending any training sessions or other function of the class, or while on the training grounds or surrounding area, including, specifically, but not limited to, any injury or damage resulting from the action of any dog, including my own, and I expressly assume the risk of any such damage or injury. 

                        Accordingly, my signature as set forth below represents my agreement to indemnify and hold harmless [Dog Works Canine Form and Function], its officers, members and instructors, from any and all claims by any person including claims by any member of my family or any other person accompanying me to any training session or function or arising while on the grounds or the surrounding area thereto as a result of any action, negligence, or omission by any person or dog, including my own. 

ACCEPTED AND AGREED TO:

By:                                                                            Date: