Application for Training

Class                                                                           
      (check schedule for class prerequisites!)

Class Date                                                                  

Class Time                                                                  

Handler Information

Handler                                                                      

Age (if under 18)                                                       

Address                                                                      

City                                                                            
State                              Zip Code                              

Phone – Day                                                              

Phone – Evening                                                        

Email Address                                                           

Have you trained a dog before?        YES        NO

If yes, where and when?                                            

Do you have, or have you had, any dogs other than the one to be trained?   YES   NO

What breeds?                                                             

How did you hear about SMDTC?

             Former Student. Who?                                 

             Current Student. Who?                                 

             Veterinarian. Which one?                             

             Groomer. Which one?                                   

             Kennel. Which one?                                      

             Newspaper

             Telephone Book

             Web

             Other. Please list.                                          

Agreement to Hold Harmless Waiver and Assumption of Risk

I understand that attendance at a dog obedience training class is not without risk to myself, members of my family, guests who may attend, or 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.

I hereby waive and release the Springfield, Missouri Dog Training Club, Inc. hereafter referred to as SMDTC, its employees, officers, members, and agents from all liability of any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session, or any other function, of SMDTC, or while on the training grounds or surrounding area thereto.

In consideration of and as inducement to the acceptance of my application for training by SMDTC, I hereby agree to indemnify and hold harmless SMDTC, its employees, officers, members, and agents from any and all claims, or claims by any member of any family or any other person accompanying me to any training session or function of SMDTC, or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

Signature of Owner or Authorized Agent                        Date      

(Minors need, a parent or legal guardian's signature)   Date      

Name of Owner (if different from Handler)                   Date      

Address                                                                                                 

City                                                        State                       Zip
..
..

Dog Information

Breed                                                                         

Name                                                                          

Date of Birth                                                              

Age                             Sex                                         

Veterinarian                                                               

Vaccinations, list date last received.  You must bring vaccination records to the first class if not included with application for training.

Rabies                                     DHPP                        

Briefly state what you hope to accomplish in training this dog?                                                                ___

Please mail your non-refundable class fee with this form, questionnaire, and a copy of your vaccination records to the address below:

Tammy Johnson
2133 W Chestnut St
Springfield, MO  65802
E-mail:  glidercrazy@yahoo.com

Make checks payable to SMDTC. All 6-week classes are $80; Home Manners and Public Manners classes $95; other classes as listed on the schedule (Package Pricing available). $5 discount for seniors (65+) on all classes. One time only $10 discount for dogs adopted from the SW MO Humane Society or a reputable rescue upon presentation of an adoption contract. PLEASE NOTE: Dogs adopted from shelters must be in the new owner's home at least two (2) weeks PRIOR to the dog attending class.

Our classes are limited to 12 dogs.  If this class has filled before your enrollment fee is received, you will be notified and put into another class or your fee returned to you.    

As a condition to acceptance of this application, the agreement to hold harmless must be signed.

Questionnaire

There are some behavior problems in dogs that obedience training alone will not solve.  Please answer the following questions so your instructor can help you or refer you to someone who can.

                         Protects food dish

                         Protects objects (toys, bones, etc.)

                         Destructive or excessive barking in

                          your absence

                         Chews furniture

                         House soiling

Has your dog ever growled or snapped at anyone?                                 YES        NO

If yes, briefly state circumstances.                             

Has your dog ever bitten any person?

YES        NO

If yes, briefly state circumstances.                             

Does your dog show aggression or fight other dogs?

YES        NO

If yes, briefly state circumstances.                             

Have you noticed any problem not mentioned, other than general disobedience?                                                 __

Briefly state any physical impairments that will affect the handler's ability to follow directions and carry out the techniques of dog training (hearing problems, impaired use of one or more limbs, etc.)