For Durham Kennel Club Members ONLY
(You must fill out this part of the form to qualify for discount classes )

Note: Services & meeting must have been completed in the last 12 months.

Date of club meeting attended:

Service #1 Date: Activity:

Service #2 Date: Activity:

Membership Type: None Member completing two required activities Instructor

For DKC Official Use Only Amt. Paid $______________ Date:__________

Owner's Name:

Address:

City: State: Zip: Phone (xxx)xxx-xxx

Email Address:

Only one person may train throughout the class, that person will be:

Handler:

If handler is under 18 years old: Indicate Age:

Dog's Name: Breed: Sex:
Birthdate:mm/dd/yyyy

Select Class: Introduction to Tracking Sunday 4:00pm

Has your dog ever growled, lifted lips, snarled, bitten or shown fear/aggression
toward people or dogs? Yes No

If yes to above question please explain:

Has your dog ever been excused from a DKC class? Yes No
If yes to above question please explain:

Class participants should follow their veterinarians’ recommendation to assure their dogs are free from internal and external parasites, any communicable diseases, and have appropriate vaccinations.

DKC requires :

Proof of Rabies, Distemper, Parvovirus and Adenovirus-2 vaccinations – you may provide one of the following:

·       A signed health certificate from your veterinarian

·       A DKC health certificate signed by your veterinarian

·       A receipt from your veterinarian listing the vaccinations given

·       A titer certificate (not for Rabies)

·       A record with labels if you have administered the vaccinations yourself (not for Rabies)

I ,by submitting this registration application to DKC, in consideration of the enrollment for obedience training being given by the Durham Kennel Club, do hereby agree that I release and waive any right that I may have in law to recover medical payments, property damages or bodily injury damages for any liability regardless of cost, provided that liability is due to ordinary negligence (This release does not contemplate wanton, willful or malicious conduct) as a result of any injury that I may sustain from any other dog or my own dog, dogs or property belonging to me, within the limits of the Durham Kennel Club headquarters or training area. I further agree that I hereby release and waive any right that I may have a law, to hold the Durham Kennel Club and/or the owner of the premises, liable for any injury which may occur to me or my dog, dogs or other property provided this injury or damage is due to ordinary circumstances of negligence. I further agree that I am assuming the risk of participating in obedience training where there are other dogs whose temperament is unknown to me, that I waive all right that I may have to institute any suit or other proceeding to cover therefore.

I have read this form and am fully aware that this contract constitutes a waiver and release of any and all liability as a result of any injury to me, to my dog, dogs or property. I hereby certify that I am over 21 years of age, am sober and of sound and understanding mind.

I accept this contract     

Signature of Owner: Date: