Application for Training Classes for First Time Students

Town & Country Animal Care Center & Training
Training Application for First Time Students

You may fax or mail this form with proof of vaccination required prior to beginning of class.
2010 N. Salem St., Apex, NC 27523 | Fax: 919.363.5077 | Phone:919.387.7833

Please read and check off each of the following before completing the form below:

I have read, completed, and understand the required Town & Country Training Application

I have provided Town & Country with the required proof of vaccination (we accept your personal veterinarian vaccination protocol)

I understand that I am requesting a Training Class, and completing this form does not constitute acceptance into the class without payment

Owner's Name: __________________________ Class:___________________________

Home: __________________ Work: ________________ Cell:_________________

Pet's Name: ______________________________________________________________

Breed: ___________________ Dog's Age: ____________ Dog's Sex: M / F

Does your dog have any physical limitations/medical problems? Y / N

Please list these here: ________________________________________________

Has your dog been neutered? Y / N When? _______________________________

Dog was acquired from (circle one): PET SHOP / SHELTER / BREEDER / OTHER:__________

Age of dog when acquired __________ How long have you had this dog? ___________

Has this dog attended an obedience class before? Y / N What level? ________________

What do you want to accomplish in this class? __________________________________

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Circle anything that applies to your dog:
GROWLS	SHY	FEARFUL	GUARDS FOOD/TOY

PUSHY	BITES	DESTRUCTIVE	WON'T LISTEN TO ME

EXCESSIVE ENERGY	DOMINANT	AGGRESSIVE	NOISY

TOO ATTACHED TO ME	MOUTHY	NOT GOOD WITH PEOPLE	NOT GOOD WITH DOGS

OTHER:______________________________________		OTHER:______________________________________

Briefly explain anything you have circled in the box above: _____________________

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

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Owner's Name: _______________________________________________________

Address: ____________________________________________________________

City: ___________________________ State: _________ Zip: __________________

All dogs handled by a minor must have prior approval from instructor. Child must weigh at least double the dog's weight in order to control dog. Children must be supervised through entire class. We reserve the right to request an adult take over training if child is unable to safely handle dog. Parents' initials________.

Check your schedule to ensure there are no conflicts, elective surgeries for your pet, vacations, etc. Make up classes are not offered. Remit this form, vaccination record and your class choice to Town & Country Animal Care Center.

Your spot in class is not reserved until completed registration form, current vaccine information, and full payment are received.

Payment is NON-REFUNDABLE. Initial:______. Spaces in classes are limited. Your payment guarantees your spot in class.

All checks are made payable to:
Town & Country Animal Care Center.

We at Town & Country Animal Care Center want to see you and your pet succeed with our training classes. Practice at home is important and will ensure that your pet will be an enjoyable and trusted family companion.

*** I understand that I am solely responsible for myself, my pet, my children, guests, and all personal belongings while on Town & Country Animal Care Center property. ***

Signature: _________________________________________________________

Date: ________________________________

Credit Card #: _________________________

Expiration Date: _______________________

Accident / Injury Release Waiver

If you have already participated in a class this year, you do not need to fill out this waiver.
We need only one waiver filled out per calendar year.

Owner’s Name:____________________________

Dog’s Name:______________________________

Class:____________________________________

Date:____________________________________

I, the undersigned, recognize, acknowledge, understand and agree that dog training or a practice session is not without the risk of harm, injury or damage to myself, members of my family, my guests and others who may be in attendance, or my dog. Because some of the dogs, including my own, to which I (we) will be exposed may be difficult to control and cause injury or damage even when managed and handled with the greatest amount of care.

In consideration of and as an inducement to the acceptance of my application for training my dog (s) and /or me, I hereby agree to indemnify and hold harmless Town and Country Animal Care Center, employees and agents for any and all claims made by me or any member of my family or any other person while on the grounds or surrounding area thereto as a result of any action by any dog, including my own, or for any other reason.

I hereby discharge and release Town and Country , its employees and agents, of and from all liability, actions, causes of action, suites, accounts, contracts, damages and any and all claims, demands from action, conduct or behavior of my dog or any other dog.

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Signature of Owner or Authorized Agent (Parent / Guardian must sign for Minors)

Date _________________________________________________