DIXIE'S Animal Training Enrollment Form

Owner(s) Name_____________________________________e-mail add____________________

Eve Phone________________________ Day Phone____________________________________

Address______________________________________City_____________Zip_______________

Puppy's Name_____________________Breed_____________Sex_______Birthday ___/___/___

Date of Last Vaccinations: DHLP______________Parvo______________Rabies_____________

Date of Last Fecal Check____________Veterinarian/Hosp_______________________________

Referred by____________________________________________________________________

In this class I want to learn:________________________________________________________

                                                                        Liability Release
I, the undersigned, hereby acknowledge that I have voluntarily applied for the services of PUPPY PALS (and its agents) for canine behavioral advising and/or dog obedience instruction. As lawful consideration for participating in these activities, I hereby agree that I, my heirs, distributees, guardians, legal representatives, and assigns will not make a claim against, sue, attach the property of, or prosecute PUPPY PALS, its owners or agents, for any injuries or damage resulting to me, my animal(s), or my property, however caused, as a result of my participation in PUPPY PALS activities. In addition, I hereby release and discharge PUPPY PALS from all actions, claims, or demands I, my heirs, distributees, guardians, legal representatives, or assigns now have or may in the future have for injury or damage resulting from my participation in this activity.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND PUPPY PALS AND I HAVE SIGNED IT OF MY OWN FREE WILL.  No Refunds After The Start of Class.

Date:____________________Signature:_____________________________________________

Please return this form to: Jane Wittstock, D.V.M. and with proof of vaccination,  fecal check and class fees to: