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Application for TrainingStudent 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: New Students: Mail this form, payment and proof of
vaccinations to: 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 _________
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