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If you prefer to submit a paper copy by
mail, click her for a
downloadable PDF file.
Click image to get FREE Acrobat Reader to open and print PDF files.
(To mail a check, click here to verify
amount of payment)
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| Full Name of Handler |
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| Age (if under 18) |
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| Address |
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| City |
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| State |
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| ZIP |
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| Email Address |
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| 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
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| Dog's Name |
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| 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 |
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| Check all that Apply -- Dog is |
Male
Female
Spayed/Neutered |
| How long have you had this dog? |
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| Owner's Name (if not Handler) |
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| Will your dog walk on a leash? |
Yes
No |
| Have you ever trained a dog
before? |
Yes
No |
| If YES, where?
(Organization/Location) |
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| If YES, when? |
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| 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? |
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What are your goals for this
class,
for the DOG? |
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| 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. |
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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".
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| Please indicate your
Preferred Start Date for your class.
(REQUIRED) |
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| Comments |
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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. |
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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.
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| Name of Owner or
Authorized Agent completing this form.
(If handler is a Minor, form must be submitted by
Parent or Guardian.) |
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