Canine U Dog Obedience Training Registration

Canine U Dog Obedience Registration Form

Minnesota Valley Humane Society
1313 Highway 13 E, Burnsville MN 55337
952-894-5000; Fax: 952-894-6669; www.MVHSpets.org

Please print and mail or fax this form to register for Canine U. Thank you! You can also register by phone by calling 952-894-5000.

Class Information

First Class Choice:

Class:____________________ Start Date:___________________ Time:____________

Second Class Choice:

Class:____________________ Start Date:___________________ Time:____________

Family Information

Names of those attending (At least one adult per dog; Children 6 and younger need instructor permission to attend):__________________________________________________

Address:_______________________________________________________________

City/State/Zip:___________________________________________________________

Contact Phone Number:___________________________________________________

Email Address:__________________________________________________________

Please describe any physical conditions or restrictions you have that might interfere with training or in any way limit your participation in this class. (optional) ___________________________________________________________

Dog's Information

Dog's Name:___________________________ Breed(s):__________________________

Dog's date of birth or current age:______________

Sex: M___ F___ Sterilized: Y___ N___

How long have you lived with this dog? ___________________________________

Where did you obtain this dog? ___________________________________

Please describe any physical conditions this dog has that might interfere with training or in any way limit his/her participation in this class. ___________________________________________________________

Dog's Habits

Where is this dog kept when someone is home? ___________________________________

Where is this dog kept when no one is home? ___________________________________

Has this dog ever bitten a person or another dog? Yes___ No___

If so, please describe how many times and the circumstances. _________________________________________________________________________

Are there other dogs in your family? If so, how many? _______________________________

How does this dog react to:

Men?__________ Women?__________ Children?__________ Strangers:__________ Other dogs?__________

What bad habits does this dog have? (Check all that apply)

Barks or howls___ Digs___ Chews___ Runs away___ Jumps up___ Gets in trash___

Pulls on Leash___ Bites___ Begs___ Puppy Mouthing___ Submissive Urination___ Separation Anxiety___

Other_____________________________________________________________

What other training classes has this dog completed? When? Where? _____________________________________________________________________________

What would you like to accomplish in this class? ________________________________________________________________________

How did you learn about our classes? _______________________________________________________

All payment is due in full with this application.
Please complete the payment information later in this form and return to MVHS promptly.

Waiver, Assumption of Risk and Hold Harmless Agreement
I understand that attendance at a dog training class of any kind 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) may be exposed may be difficult to control and may be the cause of injury or illness even when handled with the greatest of care. I agree that I will abide by all safety rules and requests provided by the Minnesota Valley Humane Society’s employees and representatives.

I hereby waive all claims for damage and release and forever discharge the Minnesota Valley Humane Society and their directors, officers, employees, instructors, assistants, volunteers, and representatives from any and all claims, damages, losses, or liabilities of any nature, for injury or damage which I, my dog, or my guests may suffer in connection with my attendance or participation in training sessions or my presence at the Minnesota Valley Humane Society or any other location including specifically, but not without limitation, any injury or damage resulting from the action of any dog. I expressly assume the risk of such damage or injury when attending any training sessions or other function, or while on the training grounds or the surrounding area thereto.

I hereby agree to indemnify, defend and hold harmless the Minnesota Valley Humane Society and any other location, their directors, officers, employees, instructors, assistants, volunteers, and representatives from any and all claims, damages, losses or liabilities, whatsoever arising out of or resulting from (1) my presence at or participation in any training session or other function while at the Minnesota Valley Humane Society or any other Canine U location or the surrounding areas thereto, (2) the presence at or participation by any member of my family or any other person accompanying me to any training session or other function while on the grounds or the surrounding area thereto and (3) any action by any dog, including my own.

I understand that if I wish to cancel, I must give notice to the Minnesota Valley Humane Society at least 1 week (5 business days) prior to the first class meeting in order to receive a full refund. Any refunds after that time will be issued at the discretion of the Minnesota Valley Humane Society.

I HAVE READ THE ABOVE AGREEMENT CAREFULLY AND FULLY UNDERSTAND THIS AGREEMENT.

Signature of all who will be attending class, and by the parent or guardian of any child who will be attending.

______________________________ _____________(Date)
Signature

Payment Information
All payment is due in full with this application.

The Complete Puppy $65

Better Dog One $85

Better Dog Two $85

Better Dog Three $85

Subtract $30 when registering with a MVHS $30 Adoption Coupon

Total $______

Mastercard ___ Visa___ Discover____ Card Number:________________________________

Expiration date:_________ Signature:_____________________________________

Please complete and return this application, your signed “Waiver, Assumption of Risk and Hold Harmless Agreement”, and check (Payable to Minnesota Valley Humane Society) or credit card number to:

Canine U
Minnesota Valley Humane Society
1313 Highway 13 East
Burnsville, MN 55337

You can also fax your application to 952-894-6669, attention Canine U or register by phone by calling 952-894-5000.

Registration in on a first come, first serve basis. If the class you desire is full, we will call to schedule you for the next available session. Please do not come to the first class until you have been confirmed. Please call 952-894-5000 with any questions.

Please send a copy of your dog’s current vaccination record along with this application. If you do not have a copy available, be sure to bring it to the first day of class. In order to keep all our class participants healthy, your dog will not be allowed in class until we have this. Veterinarians are welcome to fax records to 952-894-6669, attn: Canine U.

For MVHS Use Only

Staff Initials:________________

Class Title:_______________________ Class Start Date:________________________

Class Location: MVHS___ Peanut's Place___

Application Received By: Mail___ In-person___ Fax___ Phone___

Date Application and Payment Received:______________________ Check #_______________ V/M/DV Cash

Rung into Register? Y N RP Entered? Y N Date:_____________

Vaccination record received? Y N (Staff - Please make copy and staple to application)

Postcard Sent? Y N Date:_____________ Phone call reminder? Y N Date:_____________

Other _____________________________________________________________________