Clever Canine Fundamentals Class Registration Form

Clever Canine Fundamentals Class Registration Form

Janet Parker - www.clevercanine.ca
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 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 Janet A. Parker, and Clever Canine Training & Behaviour Consulting from any responsiblity and/or liability for any injury to myself, the individuals accompanying me, and my dog, 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 property, 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 from 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 occasionally take pictures of my dog during class. I understand that the pictures may be used judiciously to show how awesome he/she is.

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
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