*Your Name _____________________________________________ Referred by: ______________________________________

*Address_______________________________________________________*City _____________________________________

*Home Phone ___________________________ Cell Phone _______________________________

*Email ___________________________________________________________________________________________

*Class you are enrolling for: __________________________________________________________________________

*$85 Class Fee Included

Please make checks payable to Pawsitive Paws Academy

*Dog’s Name __________________________________________ *Dog’s Breed _____________________________________________

*Male or Female *Spayed/Neutered: yes no

*Dog’s Birth date or Age: ___________________

*Please attach a copy of your dog’s most recent shot records.*

Please attach a picture of your dog to this registration form.

　

I agree by my signature to hold Pawsitive Paws Academy, its members, its trainers, the owner of the premises used for training, and any party or employee of the aforementioned parties, harmless from any claim or loss which may be alleged to have been caused directly or indirectly to any person, animal or things by this dog while in or upon the premises or near the entrance thereto.

I personally assume all responsibility and liability for any such claim. I further agree to hold aforementioned parties harmless for any such claim for the loss of this dog due to disappearance, theft, damage or injury or any other causes. I am solely responsible for my children’s safety and welfare as well as their supervision during the entire time they are present on the training grounds.

*________________________________________________        *___________________

                                                                                     NAME                                                             DATE