Doggie Den Online Registration Form

Fill out the following information (bold fields are mandatory) and click 'Submit'.

First Name:
Last Name:
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Email Address:
Verify Email Address:
Home Phone:
Business Phone:
Fax:
Your Dog's Name:
Your Dog's Breed:
Dog's Gender:
Your Dog's Birth Date:
Your Dog's Weight:
Expiration Date of your Dog's last Rabies Vaccination:
DHLPP Vaccination:
Kennel Cough (Bordatella) Vaccination:
Has your dog ever bitten a person?:
If Yes, please explain:
Has your dog ever bitten another dog?:
If Yes, please explain:
What class(es) have you already completed at The Doggie Den?:
What classes have you completed elsewhere?:
Please check any problems you are currently having with your dog: Barking
Jumping Up
Chewing
Housetraining
Running Away
Aggression
Stealing Food
Pulling on leash
 Separation Anxiety
Other
Does your dog have any physical conditions,
illnesses or limitations that might affect his/her training?:
If Yes, please explain:
What course are you registering for?: Puppy Kindergarden
Beginner Obedience
Intermediate Obedience
Conformation Handling
Course Date:

You must check "Yes I agree" in order to submit your registration.

WAIVER, ASSUMPTION OF RISK AND AGREEMENT
TO INDEMNIFY AND HOLD HARMLESS

I understand that attendance at a dog training class is not without risk to myself, members
of my family or guests who may be on The Doggie Den premises, or to 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, even when supervised and handled with the greatest amount of care.

I hereby waive and release The Doggie Den, Inc./Progressive Canine Training and Behavioral Services, its employees, owners and agents from
any and all liability of any nature, for injury or damage which I or my dog may suffer,
including specifically, but not limited to, any injury or damage resulting from the action
of any dog; and I expressly assume the risk of any such damage or injury while on
the premises of The Doggie Den or in the surrounding area.

In consideration of and as inducement to the acceptance of my application for
participation in a dog training class, I hereby agree to indemnify and hold harmless The
Doggie Den, Inc/Progressive Canine Training and Behavioral Services, its employees, owners and agents from any and all claims, or claims by
any member of my family or any other person accompanying my dog on The Doggie Den
premises or in the surrounding area as a result of any action by any dog, including my own.

I understand that there are no refunds once my class begins.

Yes, I Agree to the Waiver Above