Training/Event Application



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(To mail a check, click here to verify amount of payment)
 

Full Name of Handler  
Age (if under 18)  
Address  
City  
State  
ZIP  
Email Address  
Day Phone   (Please Include Area Code)
Work Phone

 
    (Please Include Area Code, and EXTENSION if applicable)

Evening/Weekend Phone   (Please Include Area Code)
Please note that Email addresses and complete Phone contact information are important
in the event classes need to be cancelled due to weather or other emergencies.
How did you hear about Redfern Canines?                   ----- Please check all that apply -----
 
Website   Friend   Newspaper (Ad)
 Veterinarian   Poster   News (Item)
 Previous Class   Pet Calendar (Patriot)
 CentralPaDogs.com     Hbg Kennel Club
 Business Card     Match Show Bulletin
 Other -- Specify ę 
Dog's Name  
Breed  
If your dog is a MIXED breed, please give some indication regarding  the possible breeds, such as "Shepherd/Lab" or "Poodle/Golden" or "Sheltie/Border Collie", etc. 
Dog's Age  
Check all that Apply -- Dog is Male Female  Spayed/Neutered
How long have you had this dog?  
Owner's Name (if not Handler)  
Will your dog walk on a leash?   Yes     No
Have you ever trained a dog before?   Yes     No
If YES, where? (Organization/Location)
If YES, when?
Has your dog shown any signs of aggressiveness or viciousness?   Yes     No
If YES, was it toward People, or Other Dogs, or Both
What are your goals for this class,
for the HANDLER?
 
What are your goals for this class,
for the DOG?
 
Vaccination Information All dogs participating in any class or event MUST have current vaccinations as of the start of the class or event. Veterinary Record documentation (Receipt or Statement) is REQUIRED, and must be presented before start of the first class.

Last Vaccination Date:    (Month/Year)

Rabies  
DHLPP  
Kennel Cough (Bordetella)  
Veterinarian  
Class or Event Requested
See current Class Schedule for
Description and Class Time offerings

Please verify the availability of your class Date and Time before submitting a payment. 

Check the Class Schedule page to verify that the class and Start Date you prefer is NOT "Closed".

 

6-Week Classes     [Click for Secure Payment]
Puppy Class Beginners Class
Manners Class Kids N K9s
Rally Obedience --
       Level 1
Rally Obedience --
       Level 2
Agility -- Level 1 Agility -- Level 2
Obedience Competition
       -- Level 1, Novice
Obedience Competition
       -- Level 2, Advanced
Conformation
       Competition
       Preparation
Introduction to Clickers
   
5-Week Classes    [Click for Secure Payment]
K9 Sampler CGC/Therapy Dog
       Preparation
   
4-Week Classes    [Click for Secure Payment]
Loose Leash Walking Reliable Recalls
   
3-Week Classes    [Click for Secure Payment]
Attention Tuning Tricks
   
2-Week Classes    [Click for Secure Payment]
   
 
Other Events
CGC/Therapy Dog
       Evaluation
Doggie Day Camp
Housetraining Hints for
       your Puppy
Choosing a Puppy
   
Seminar -- The Power
       of the Clicker
     
 (Introduction to
       Clicker Training)
Seminar -- The Healing
       Power of a Dog
    
 (AAT/AAA for Handlers)
Seminar -- First Aid for
       Dogs
 Seminar -- Dogs &
        Storks
Seminar -- Before You
      Get a Dog -- How to
      Pick Your Perfect Pal
      (FREE)
 
Seminars must be pre-paid -- click here to pay online
   
Private Training Private Consultation
   
Other (Specify)     
Please indicate your Preferred Start Date for your class. (REQUIRED)  
Comments  
   

Payment must be presented
prior to the start of class.
ONLINE PAYMENTS are available for
Regular Classes and Seminars

REFUND POLICY:  CLASSES -- Refunds will be subject to a $5.00 processing fee.  SEMINARS -- Refunds will be subject to a $25.00 processing fee.


Agreement to Hold Harmless, Waiver, and Assumption of Risk

I understand that participation in Dog Training Classes is not without risk to myself, members of my family, or guests who may attend. Some 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 amount of care. 

In consideration of and as inducement to the acceptance of application for training by Redfern Canines Inc (hereinafter referred to as the “Training Organization”), I hereby agree to indemnify and hold harmless this Training Organization, its employees, officers and agents from any and all liability of any nature, and from any and all claims by any member of my family or any other person accompanying me to any training session or function of the Training Organization, 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, including my own. I expressly assume the risk of such damage or injury while attending any training session, or any other function of the Training Organization, or while on the training grounds or the surrounding area thereto. 

I certify that I am 18 years of age or older, that I have read this entire Waiver, and that I fully understand the provisions of this Waiver and intend to be legally bound hereby.
 

Name of Owner or Authorized Agent completing this form. (If handler is a Minor, form must be submitted by Parent or Guardian.)  


BEFORE CLICKING to SUBMIT THE APPLICATION:
    
[1] please verify that all information is complete, and
     [2] please verify that you have selected a Class or Event, and
     [3] please verify that payment has been submitted.  
          
ę  Click here for Secure Payment Online

We accept PayPal, VISA, MasterCard, American Express and Discover
PayPal accepts all major Credit Cards

 

    

 

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[Training/Event Application]
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11.08.08

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Member, Harrisburg Kennel Club,
Association of Pet Dog Trainers

International Association of Animal Behavior Consultants
The Labrador Retriever Club, Inc.

For additional information on the above organizations, click on the logos or links

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