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CDTC AGILITY CLASS REGISTRATION - Charlotte Dog Training Club

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CDTC AGILITY CLASS REGISTRATION - Charlotte Dog Training Club Powered By Docstoc
					    Dear Agility Class Applicant:
    Enclosed are applications for Charlotte Dog Training Club’s training classes. Orientation will be on Monday, Sept. 14, 2009 at 7 PM. Classes are held
    outdoors plan to dress appropriate to the weather.

    For the health of your pet and others, we require proof of current vaccinations and parasite exams. You will not be allowed in class without providing this
    information. Please return the attached health certificate with your application. Your dog must be current on DHLP, Parvo, Rabies and Bordetella.

    If you have questions concerning the classes, application, or health form please call 704-529-2989.

    The deadline for applications is September 4, 2009. PLEASE RETURN APPLICATION, CLASS FEE (PAYABLE TO CDTC), AND HEALTH
    RECORD TO:
                                                       CDTC AGILITY CLASS REGISTRATION
                                                                c/o JUNE LAUCH
                                                               13600 Quigley Lane
                                                              Charlotte, NC 28273

                                                                          AGILITY CLASSES
    Agility classes consist of an orientation followed by 8 weeks of class. Orientation that will be held on Monday, September 14, 2009 at 7 PM. Classes
    are held at the Piedmont Kennel Club Showplace on Choate Circle off of Carowinds Blvd.
    Class fee: $150 for the eight-week course.
    No refunds will be made after the first night of class. In case of emergencies or circumstances beyond your control, please advise your instructor
    immediately.
    Please complete the enclosed application and return it with your payment by the September 4, 2009 deadline. You will receive a confirmation e-mail
    before classes start. If you did not make the deadline for class, or the class is full, your application and payment will be shredded.

                                                              AGILITY CLASS DESCRIPTIONS
                                       ALL CLASSES WILL BE HELD ON MONDAY OR WEDNESDAY EVENINGS.
     Foundations 1: This is the beginning class required for learning agility skills. Dogs will begin with “baby equipment” and progress from there.
    Prerequisites: Completion of Performance Sports, Competitive Edge class or clicker knowledge, good stays, and consistent recall or instructor approval.
     Foundations 2: This class builds on the skills learned in Foundations I. At the end of this class dogs should be able to confidently perform contact
    obstacles, jump all types of jumps, and run simple sequences. Prerequisite: Successful completion of Foundations I or instructor approval.
     Handling/Box Work: Will address handling skills for multiple levels. We will be using a double box set up to perfect handling cues and systems.
    Prerequisites: Completion of Foundations I and II or instructor approval.

NOTE: We limit registration so classes fill very fast. Get your application in quick to secure a spot in class!
    C harlott e Dog Training Club
               Public Class Application
                  Agility ~ Fall 2009
                                                                 How long have you owned this dog?_________            *Deadline for application Sept 4th
  Deadline for application Sept. 4th                                                                                        Please return application and class fee
                                                                 Where did you obtain this dog? Breeder
           Class Fee is $ 150                                    Ad     Shelter    Breed-Rescue Friend                              (payable to CDTC) to:
Complete a SEPARATE application for each dog &                   Pet Store      Other________________________
class                                                                                                                  CDTC AGILITY CLASS REGISTRATION
                                                                 Where is this dog kept?___________________                          c/o JUNE LAUCH
         Monday 6:45 – 8:00 PM                                   Has this dog ever bitten anyone_______If so                        13600 Quigley Lane
                      Foundations 1                               please explain:__________________________                          Charlotte, NC 28273

    Wednesday 6:45 – 8:00 PM:                                    Has this dog ever been in a fight with another                             RELEASE
                                                                 dog?___ If so please explain:________________
                      Foundations 2                              ________________________________________
                                                                                                                         Applications without signed release will be
                                                                                                                                    returned to the applicant.
                                                                 How would you describe your dog?                    I, the undersigned due hereby agree to release
     Wednesday 8:15 – 9:00 PM                                    (Mark all that apply)                                and hold harmless Charlotte Dog Training Club,
                Handling & Box Work                              Dominant               Playful         Loud          its entities and subsidiaries from any legal liability
                                                                 Confident              Fearful         Calm          for any bodily injury, personal injury and/or
                                                                 Friendly           Dependent           Quiet         property damage associated with any club
*Deadline for application March 2nd*                             Aggressive         Submissive          Shy           function. This includes, but is not limited to any
Handlers must be at least 13 years of age. Any                                                                        event held at the club location and/or any other
                                                                 What bad habits does this dog have?
handler under 18 years of age must be                                                                                 facility in connection with the Charlotte Dog
                                                                 (Mark all that apply)
                                                                                                                      Training Club.
accompanied to all classes by a parent or legal                  Barks               Digs        Runs Away
guardian who is required to remain in the building               Bites              Growls         Jumps Up
                                                                                                                      I further release and hold harmless, Piedmont
throughout the class.                                            Begs               Chews
                                                                                                                      Kennel Club, its subsidiaries and entities from any
                                                                 Gets In Trash        Other____________________
Dog’s Name___________ Breed_____________                                                                              legal liability for any bodily injury, personal injury
                                                                 Has this dog had prior obedience or agility         or property damage while on the physical property
Dog’s Age:______ Spayed/Neutered?                 Yes            training? How much and where?______________          of the club.
No                                                               List titles earned by this dog?_______________      Undersigned hereby declares the terms of this
Handler:________________________________                         Have you earned titles on previous dogs? Yes   No   release to be valid from the time of signature until
Is Hander Under 18?   Yes or No                                                                                       my valid membership has expired. I also agree to
                                                                 List future goals for yourself and this             act as agent for any family member who is under
                                                                 dog:____________________________________             18 and for whom I am responsible.
Address:_________________________________
                                                                 Have you taken previous classes at CDTC?
City, State, Zip:___________________________                     List classes & dates
                                                                                                                      Signature of Handler                            Date
Email:__________________________________

Primary Phone #:_________________________                         If you have questions concerning Agility class
                                                                                                                      Signature of Alternate Handler                  Date
                                                                  or the application please direct your inquiries     Or Parent or Legal Guardian if Handler is under 18 years old
Alternate Phone #:_________________________                                             to:
                                                                                                                      Club Use: Rec’d______________Ck#_________$________
                                                                                 jlauch@bellsouth.net                 Release______ HC____Missing_______________________
Emergency Contact: _______________________                             (If you do not have email call 704-583-5924)

Emergency Contact Phone #:_____________________
                     VACCINATION RECORD / HEALTH CERTIFICATE
                                  CHARLOTTE DOG TRAINING CLUB ~ AGILITY ~ FALL 2009
CALL NAME OF DOG_________________Breed_____________________Age______ SEX                          F     M   SPAY/NEUTER          Y    N

Name of Owner________________________________Address_______________________________________________________



VACCINATION RECORD – FILL IN DATES OF MOST RECENT INOCULATIONS
All of the following vaccinations are required to participate in classes.
DISTEMPER (DHLP) _______________ *RABIES _______________ PARVO ______________ BORDETELLA________________

*NC state law requires a dog receive a rabies vaccination by 4 months of age, which is valid for 1 year. Subsequent rabies vaccinations are valid for 3 years. CDTC
requires dogs be current on this vaccination. If your dog’s rabies vaccination will expire during the class session you will be asked to provide documentation of re-
vaccination no later than the date the vaccination expires.)



                                             DATES OF MOST RECENT LABORATORY EXAMINATION AND RESULTS
       For Dogs 1 yr or younger, exam must be within 30 days of class, For dogs older than 1 yr, exam must be within 9 months of class

Fecal Exam: Date_______Result________; Otoscopic Exam: Date______Result_______;External Parasites: Date______Result_________

TREATMENT FOR ABOVE IF NECESSARY___________________________________________________________________




Is this dog presently on Heartworm Preventative?            Yes     No (RECOMMENDED BUT NOT REQUIRED FOR CLASSES)


It is not necessary to use this form. It is provided for the convenience of the Veterinarian. Another form containing the same information and signed by the Veterinarian
may be substituted. A Health form must be presented for your dog to participate in classes.


VETERINARIAN’S NAME
(Please Print)_____________________________________________CLINIC____________________________________________

VETERINARIAN’S SIGNATURE __________________________________________ DATE _____________

				
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