Obedience Class Application - Plantation Animal Hospital

Plantation Animal Hospital
Puppy/Dog Obedience Application
About you:
Name: _________________________________________________________________________________
Address:_______________________________________________________________________________
City:_____________________________________State:_____________________Zip:_______________
Phone: (H)___________________________________ (C)_____________________________________
Emergency Contact - Name: ___________________________ Phone: _____________________
About your puppy/dog:
Name:__________________________________________________________________________________
Breed:________________________________ Age:_______________ Sex: M___ F___ S___ N___
How long have you had this dog: ___________________________________________________
Have you owned a dog before? Y / N Have you trained a dog before? Y / N
What do you wish to accomplish: __________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
What major problems have you had so far?: _______________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Agreement to hold harmless, waiver, and assumption of risk
I understand that attendance of a dog obedience training class is not without risk to
myself, members of my family, or guests who may 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 amount of care.
Therefore, I hereby waive and release PLANTATION ANIMAL HOSPITAL, its
employees, members, and agents from any and all liability of any nature, for injury
which I, my dog, or my personal property may suffer, including specifically, but
without limitation, any injury or damage resulting from the action of any dog. I
expressly assume risk of such damage or injury while attending any training
session, or while on the training grounds or the surrounding area thereto.
In consideration of and as inducement to the acceptance of my application for
training, I hereby agree to indemnify and hold harmless Plantation Animal Hospital,
its employees, members and agents from any and all claims, or claims by any
member of any family or any other person accompanying me to the training session
as a result of any action of any dog, including my own.
Signature of Owner
Date