Los Alamos Dog Obedience Club Online Class Registration
Registration form for dog training classes at Los Alamos Dog Obedience Club.
Handler and Dog Information
Owner's name: Last, First *
Your answer
Daytime Phone: *
Your answer
Evening Phone: *
Your answer
Email Address *
Your answer
Street *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Dog's Name *
Your answer
Dog's Breed
Your answer
Dog's Date of Birth (estimate if not known) *
Your answer
DHPP vaccination expiration: mm/dd/yy
Your answer
Is this a shelter or rescue dog?
(Proof of adoption required for reduced fee.)
Has this dog taken a LADOC class before?
Which class or classes have you taken?
Your answer
Bite History
Has this dog ever bitten (broken skin) on another animal or human?
Was veterinary or medical treatment required?
Please explain the incident.
Your answer
Reactivity and Sociability
These questions are about your dog's reactivity and sociability with other dogs and humans in public situations.
When taking your dog on a walk and you encounter other people, my dog: *
check all that apply
Required
When taking your dog on a walk and you encounter other dogs, my dog: *
check all that apply
Required
Class Selection
Choose the class you and your dog are enrolling in.
Class Selection *
Select the class from the drop down menu you want to enroll in.
Date and time of selected class:
If multiple sections are offered, please indicate preferred day and/or time:
Your answer
Comments or concerns:
If you have any special concerns, please note them below.
Your answer
Risk and Responsibility
Assumption of Risk and Responsibility: I (we) recognize that there is a risk of injury to myself (ourselves) and this dog by participating in this class. The risks include, but are not limited to, dog bites, illness, and injury sustained while using club equipment. I (we) agree to hold the Los Alamos Dog Obedience Club, its members, directors, officers and instructors and the owner or lessor of the premises and any employee of the aforementioned parties, harmless from any claim or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in the class or upon the premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim. I (we) further agree to hold the aforementioned parties harmless from any claim for loss of this dog by disappearance, theft, damage, or injury, caused or alleged to be caused by the negligence of the Club or any of the parties aforementioned, or by the negligence of any other person, or any other cause or causes. I (we) hereby assume the sole responsibility for and agree to indemnify and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting there from, sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or in consequence of my (our) participation in this class, howsoever such injuries, death, or damage to property may be caused, and whether or not the same may have been caused or may be alleged to be caused by negligence of the aforementioned parties or any of their employees or agents, or any other persons.I (we) understand that there will be no refund if my dog is dismissed for aggression, I (we) have read the above statement, and by reason of my (our) acknowledgment do hereby attest that I (we ) have read the registration guidelines and that I (we) agree to the terms and conditions of this release. I acknowledge this release:
I have read the above statment *
Required
Signature (typing your name in this box is the same as written signature) *
Bring your vaccination records and payment the first night of class.
Your answer
Date *
MM
/
DD
/
YYYY
We may be able to accept late registrations if space is available.. Contact the registrar for instructions at: ladocregistrar@gmail.com
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