Instr Verified: Shots Curr: ____ Fecal Curr: ____ Waiver ____ 03/14/2021
PAW & HAND CLASS REGISTRATION
317 S. Market St, Muncy, PA 17756 (snail mail); 570-980-1546
Physical Location: 2164 Route 405 Hwy, Muncy, PA 17756
OWNER’S NAME: ____________________________________________________________
STREET/PO BOX/APT #: ______________________________________________________
CITY, STATE, ZIP: ____________________________________________________________
Pref Ph#: ____________________________ Circle One: Mobile Home Work
2ndary Ph#: _____________________________ Circle One: Mobile Home Work
EMAIL ADDRESS: ____________________________________________________________
Main Problem/Concern You Wish to Correct:______________________________________
____________________________________________________________________________
Has your dog shown any signs of aggression or reactivity toward other people or other dogs? This includes lunging and barking menacingly? Yes or No (circle)
If yes to above please explain: _________________________________________________ ____________________________________________________________________________
CLASS: ____________________________________________________________________
Please check the schedule prior to completing this section
Circle Your 1st Choices: DAY: Mon Tues Wed Thur Sat TIME: AM AFTN EVE
Circle Your 2nd Choices: DAY: Mon Tues Wed Thur Sat TIME: AM AFTN EVE
I attest that my dog has had the following vaccinations/tests on the dates indicated:
DISTEMPER/PARVO/PARAINFLUENZA: ___/___/_______ Last fecal test___/___/_______
BORDATELLA: ___/___/______ RABIES (dogs under 12 wks exempt):___/___/_______
Vaccination and fecal records must be presented before the first class.
PAYMENT: Make Checks Payable to: Paw & Hand Obedience AMT Pd: $___________
Mail to: Paw & Hand Obedience, 317 South Market St, Muncy, PA 17756 (or pay online)
I understand that attendance at a dog obedience class is not without risk to myself, members of my family or guests who may attend, or to my dog. I hereby waive and release Paw & Hand, Lana Kline, John Kline, their agents, the instructors, and Mike Sullivan and his family & agents, from all liability or damages of any nature, including theft, resulting from actions of any dog or handler while on the training grounds, training room, house, buildings, or surrounding area. I also acknowledge that I have read the payment and pottying policies information printed below.
Potty your dogs to the west of the building, away from the building and parking BUT NOT ON THE NEIGHBOR’S LAND. There will be poop bags and a “poop only” can outside for your use. Do NOT put poop in the green & yellow recycle bin. Do not let your dogs urinate anywhere close to the building or on the heat pump. YOU MUST CLEAN UP AFTER YOUR DOG!!! No exceptions. Failure to follow this rule could result in you being expelled from classes and activities. Minors must be accompanied by a parent or guardian.
YOUR SPOT IN CLASS IS NOT GUARENTEED WITHOUT PAYMENT. NO REFUNDS FOR CLASS FEES UNDER ANY CIRCUMSTANCES. Separate P&H Waiver must be signed if it is not included on the back of this form
Page 2, P&H Reg Form
PAW & HAND OBEDIENCE
Agreement to Hold Harmless Waiver & Assumption of Risk
I understand that attendance at a dog obedience/agility training class or school related event is not without risk to myself, members of my family, guests who might attend, or to my dog, because some of the 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 of care.
I hereby waive and release Paw & Hand Obedience, hereinafter referred to as "Paw & Hand", its owner, employees, instructors, agents, and landlord, Mike Sullivan, his family and agents, from any and all liability of any nature 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 or injury or damage arising from COVID-19, or any communicable disease to either myself/handler, or my dog. By signing this waiver, I voluntarily assume all risks related to exposure to COVID-19. I expressly assume the risk of such damage or injury while attending any training session, or any other function, of Paw & Hand, or while on the training grounds or the surrounding area thereto.
In consideration of and as inducement to the acceptance of my participation in any and all Paw & Hand events, classes, workshops, matches and other activities, I hereby agree to indemnify and hold harmless Paw & Hand, its owner, employees, instructors, agents, Milke Sullivan, his agents, from any and all claims, or claims by any member of a family or any other person accompanying me to any training session or function of Paw & Hand, or while on the grounds or the surrounding area thereto, as a result of any action by any dog, including my own.
By participating in classes or events at Paw & Hand Obedience, I understand that both I and/or my dog(s) will be working with, exposed to or otherwise be in the presence of other dogs. I understand that neither Paw & Hand Obedience, its owner, employees, agents, and/or its instructors and landlord, do not warrant or otherwise insure my safety or the safety of my dog during events, classes or periods proceeding or following events or classes hosted by Paw & Hand Obedience.
In the event that either my dog or I are injured by another dog prior to, during or following an event hosted by Paw & Hand Obedience, I agree to hold harmless Paw & Hand Obedience, its owner, employees, agents, instructors, and landlord for any injury suffered or sustained by myself and/or my dog(s).
I understand that this hold harmless agreement is a condition of my participation at Paw & Hand Obedience classes and/or events and is part of the consideration exchanged between Paw & Hand Obedience and me for the privilege of participating in events and/or classes at Paw & Hand Obedience.
I have read this agreement and understand the conditions of participation.
X____________________________________________________ _______________________
Signature (if under 18, must be signed by a parent or guardian) Date
__________________________________________________________ Printed Name
NOTE: Minors MUST be accompanied by a parent or adult guardian. During COVID restrictions, no extra people may attend group classes, so no minor handlers in group classes during COVID.
More than one person may be present during private lessons, therefore minors may be able to handle dogs during private lessons.