Clever Canine Fundamentals Class Registration Form

Name *

First Name Last Name

E-mail *

Phone Number - Home

- Area Code Phone Number

Phone Number - Cell

- Area Code Phone Number

Dog's Name: *

Dog's Age: *

How long has your dog lived in your home?

1 week? 1 month? 1 year?

Dog is a ... *

female male

Dog's Breed: *

Is your dog spayed/neutered? *

Yes No

My dog: (please check all that apply) *

loves people is shy with people is shy at first but warms up loves other dogs is afraid of other dogs is afraid at first but warms up

Class Start Date:

Check Clever Canine's Website for possible dates

I have looked at the dates for my chosen class and know that I will miss:

1 class 2 classes 3 classes (not recommended)

Class dates I will miss:

eg Jan 12, Feb 14

My goals for my dog and me in this class:

Please choose your method of payment: *

E-Transfer PayPal Cheque Cash

Click here to read about Clever Canine's policies regarding payments, refunds and make-ups

Clever Canine's Policies regarding Refunds and Make-ups: *

I have read the policy and agree

Clever Canine Waiver of Liability

I agree that dog training can be a hazardous activity. I agree to absolve the property owners of 1st Cedar Hill Scout Hall (at 3680 Cottonwood Street), and any other location used by Clever Canine Training & Behaviour Consulting, as well as Janet A. Parker, from any responsiblity and/or liability. I take full responsibility for any injury to myself, the individuals accompanying me, my dog, and my vehicle, as well as any injury/damage caused by me, the individuals accompanying me, my dog or my vehicle which occurs at any Clever Canine training location.

Furthermore, I understand that my dog's behaviour now and in the future is soley my responsibility as the owner/handler of the dog. Should any behaviour on the dog's part now, or in the future, result in damage to the property, owners, or person of some third party, I, the owner agree to assume full responsibility and liability to such third party for any and all damages, and to absolve Clever Canine Training & Behaviour Consulting and Janet A. Parker form any and all obligations to pay such damage to a third party.

Clever Canine Waiver of Liability: *

I have read the waiver and agree

I agree to allow Clever Canine to use images of myself or my dog in any advertising or promotional media.

Yes No

I would like to receive free training tips and advice via Clever Canine's e-newsletter:

Yes please!

How did you hear of our classes?

On-line Veterinarian Friend Dog Walker Groomer Other