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If you prefer to submit a paper copy by
mail, click here for a
downloadable PDF file.
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(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
Veterinarian
Poster
Previous
Class
Hbg
Kennel Club
Business
Card
Other
-- Specify ?/font>
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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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| Dog is |
Male
Female |
| How long have you had this dog? |
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| Owner's Name (if not Handler) |
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| 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? |
|
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. |
|
STOP!!!!
Before proceeding, please note that
you must select ONE Class
or Event
before completing this form.
Forms submitted without a class or
event selected may result
in a delay or rejection of the application. |
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".
Please select ONLY ONE
class or event
per Application
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".
Please select ONLY ONE
class or event
per Application
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 select ONLY ONE
class or event
per Application
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".
Please select ONLY ONE
class or event
per Application
|
|
| 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 $10.00 processing fee.
SEMINARS -- Refunds will be subject to a $25.00 processing fee.
A refund will be provided if written notice of
withdrawal from class is received at least 24 hours prior to the
start of class sessions.
There will be no partial refunds for classes
missed,
or if the student withdraws from class after sessions begin. |
|
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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