Make your own free website on Tripod.com

Home
Summer Fun Runs
Instructors
Our Dogs
Student Form
Class Application
Class Schedule
Pricing
Training Site
In Memory

Application for Training

Student Information

Name:__________________________ Date:____________

Address: ________________________________________

City, State: ____________________ Zip Code: __________

Hm. Phone (      ) __________Wk. Phone (       ) __________

Other Phone (      ) _________ E-mail __________________

Canine Information

Name: __________________________ Age: ___________  

Breed: _______________ Male ___ Female ___ Fixed_____

Other Information

Obedience commands your dog knows _________________

Are you interested in competing in agility?______________

Desired Class: Level _________ Starting Date____________

Agreement

I (we) agree to hold Phoenix Flyers Dog Agility Training and Pam Stubbs and any employees of the aforementioned parties from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or upon the premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim, and I (we) further agree to hold the aforementioned parties harmless from any claim for loss of this dog by disappearance, theft, death or damage or injury, be caused or alleged to be caused by the negligence of Phoenix Flyers or any of the parties aforementioned, or by the negligence of any other person, or any other cause or causes.

I (we) hereby assume the sole responsibility for and agree to indemnify and save the aforementioned parties harmless from any and all loss and expenses (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at anytime resulting therefrom, sustained by any person, including myself (ourselves) on or account of damage to property, arising out of or in consequence of my (our) participation in agility training, howsoever such injuries, death or damage to property may be caused, and whether or not the same may have been caused or may have been alleged to have been caused by negligence of the aforementioned parties or any of their employees or agents, or any other persons.

Signature ___________________________ Date _________

Continuing Students: Mail this form, payment and proof of vaccinations to:
Phoenix Flyers
c/o Lynda Pemberton
6345 N. 19th Drive
Phoenix, AZ 85015

New Students: Mail this form, payment and proof of vaccinations to:
Phoenix Flyers
c/o Chris Hill
7602 W. John Cabot Rd.
Glendale, AZ 85308

Please note that all applications must be submitted and approved prior to the start of the first class session.

FOR OFFICE USE ONLY

Vaccinations

DHLP __________     Parvo _________    Rabies _________

 

Home ] Summer Fun Runs ] Instructors ] Our Dogs ] [ Student Form ] Class Application ] Class Schedule ] Pricing ] Training Site ] In Memory ]

Send e- mail to Chris Hill or Lynda Pemberton for more information.
Send e- mail to the Webmaster with comments about this web site.
Copyright 2000 - 2013 Phoenix Flyers Dog Agility Training
Last modified: August 31, 2013