ccaenrollmentform

							                                            C l a s s E nr ol l m e nt F or m
 Fill in this form, print it and sign it and then bring it to the center with all documents, preferably on a date prior to beginning class.
                        This way we can check all your information, meet your best friend and show you around.

                                                                                                   FEE: $___________ per ___ weeks
                                                                                                   PAID: __ Check # ____ Cash ____
                                                                                                              (Fees for center use only)
Class: _______________________
Date & Time: _________________
                 (For center use only)

                                                           OWNER INFORMATION
                                (Type in fields then tab to next field all will expand as you type, all information required)

NAME:                                                DATE (mm/dd/yyyy):

ADDRESS:

CITY/STATE/ZIP:

PHONE: Home: (000)000-0000 WORK: (000)000-0000 Ext:                                  Cell: (000)000-0000

E-mail:

EMERGENCY CONTACT: NAME & PHONE:

                                                              DOG INFORMATION
                                             (Does not need to be a pure breed to participate and have fun!!)

DOG’S NAME:               BREED:                DOG’S AGE:             years old (put 0 for under 1 year) BIRTH DATE:

Dog’s attitude toward people (check one)                              Friendly      Reserved       Shy/timid
                                                                      May Bite/Snap      Will Bite/Has Bitten

Dog’s attitude toward other dogs (check one)                          Friendly      Reserved       Shy/timid
                                                                      May Bite/Snap      Will Bite/Has Bitten

Vaccinations Required: Distemper, Parvo, Rabies, and Bordetella
Copies of shot records or titer results must be produced before the first class.

Date Records provided and verified: (For center use only) Date: ___________ Verified by: ______________ Exp Date: _______

Has your dog been spayed or neutered (check one)            YES           NO

How long have you had this dog?            years

Did you get this dog from a breeder? YES                 NO           Rescue: (Name of shelter)


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What are your goals with this training?   (Give us as much info as possible to ensure your dog gets the training you want)



What previous training have you done with this dog/puppy?


What training methods have you used? (check as many as you have done) Luring               Clicker       Aversive (shock, etc.)

Others (list)

                   WAIVER, ASSUMPTION OF RISK, AND AGREEMENT TO HOLD HARMLESS

1.       Assumption of Risk: I, Fill your name in here understand that attendance at a dog training class is not without risk to
myself, members of my family, or guests who may attend, or my dog, because some of the dogs to which I (we) will be exposed
may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. The
undersigned is voluntarily engaged in dog classes as a recreational activity with the knowledge of the risks of injury, death, or
property damage that may result from participation in dog training.

2.         Release of Liability: In consideration of and as inducement to the acceptance of my application for training
membership in this training class, I hereby agree to indemnify, hold harmless, and release Carson Canine Adventures, LLC,
(hereinafter CCA) its members and officers, employees, and its representatives and Contracted Dog Trainers from any and all
liability of any nature, including, but not limited to, claims, damages, or demands for personal injury, death or property damage
to the undersigned or the undersigned’s dog or dogs, arising from or related to my participation in dog training and this
agreement. The undersigned bears sole responsibility for any loss and expressly assumes the risk of any such damage or injury
to themselves, their dog (s), members of their family or any other person accompanying them while attending any training
sessions or other function taught by or at CCA, or while on the training grounds located at 580 Mallory Way, Carson City,
Nevada, or as a result of any action by any dog, including my own.

3.       Knowing and Voluntary Execution: The undersigned acknowledges that he/she has carefully read this agreement,
understands its contents and understands that this agreement includes an assumption of risk of dog training and competitive dog
sports and agrees to release from liability CCA, its Members and Officers, employees and its representatives, and Contracted
Dog Trainers, and further understands that this is a complete release of liability and a promise not to pursue litigation or make a
claim. The undersigned acknowledges that this is a contract between the undersigned and CCA and that CCA, its Members and
Officers, its representatives, and Contracted Dog Trainers are materially relying on this waiver in allowing the undersigned to
participate in these dog training classes.

4.         By signing this, I also state that my dog(s) is/are not aggressive towards people or other dogs. While on the grounds or
in a training session, I agree to not use any form of punishment on my dog including, but not limited to, yelling, hitting, e-
collars, or prong collars. I also agree to be responsible and not let my dog urine mark or defecate on or in the building or on the
equipment and to clean up after my dog in case any of this behavior should occur on, in, or around the facility. I understand
that if I use any aversive methods or fail to take responsibility for my dog, that I breach this agreement and may be asked to
leave the premises and not be allowed to return to class and, as a result, release my rights to a refund of monies paid. I also
agree that this Agreement shall be valid for one year from the date of signature hereon.

SIGNATURE OF OWNER OR AUTHORIZED AGENT: _____________________________________________

SIGNATURE OF HANDLER IF NOT THE SAME AS ABOVE: _______________________________________

IF A MINOR, SIGNATURE OF LEGAL GUARDIAN: ______________________________________________

NAME, ADDRESS, AND PHONE NUMBER(S) OF OWNER OF DOG, IF DIFFERENT FROM ABOVE



TODAYS DATE: _________________




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