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The information which you provide on this form is for the sole use of Performance Dog Training and will remain confidential.
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Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Dog's Name
*
Breed
*
Affenpinscher
Afghan Hound
Airedale Terrier
Akita
Alaskan Malamute
All American
American Bulldog
American English Coonhound
American Eskimo
American Foxhound
American Pit Bull Terrier
American Staffordshire Terrier
American Water Spaniel
Anatolian Shepherd
Australian Cattle Dog
Australian Shepherd
Australian Terrier
Basenji
Basset Hound
Beagle
Bearded Collie
Beauceron
Bedlington Terrier
Belgian Malinois
Belgian Sheepdog
Belgian Tervuren
Bergamasco
Bernese Mountain Dog
Bichon Frise
Black Russian Terrier
Black and Tan Coonhound
Bloodhound
Bluetick Coonhound
Boerboel
Border Collie
Border Terrier
Borzoi
Boston Terrier
Bouvier des Flandres
Boxer
Boykin Spaniel
Briard
Brittany
Brussels Griffon
Bull Terrier
Bulldog
Bullmastiff
Cairn Terrier
Canaan Dog
Cane Corso
Cardigan Welsh Corgi
Cavalier King Charles Spaniel
Cesky Terrier
Chesapeake Bay Retriever
Chihuahua
Chinese Crested Dog
Chinese Shar-Pei
Chinook
Chow Chow
Clumber Spaniel
Cocker Spaniel
Collie (Rough and Smooth)
Coton de Tulear
Curly-Coated Retriever
Dachshund
Dalmatian
Dandie Dinmont Terrier
Doberman Pinscher
Dogo Argentino
Dogue de Bordeaux
English Cocker Spaniel
English Foxhound
English Setter
English Springer Spaniel
English Toy Spaniel
Entlebucher Mountain Dog
Field Spaniel
Finnish Lapphund
Finnish Spitz
Flat-Coated Retriever
French Bulldog
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Wirehaired Pointer
Giant Schnauzer
Glen of Imaal Terrier
Golden Retriever
Goldendoodle
Gordon Setter
Great Dane
Great Pyrenees
Greater Swiss Mountain Dog
Greyhound
Harrier
Havanese
Hovawart
Ibizan Hound
Icelandic Sheepdog
Irish Red & White Setter
Irish Setter
Irish Terrier
Irish Water Spaniel
Irish Wolfhound
Italian Greyhound
Japanese Chin
Keeshond
Kerry Blue Terrier
Komondor
Kuvasz
Labrador Retriever
Labradoodle
Lagotto
Lakeland Terrier
Leonberger
Lhasa Apso
Löwchen
Maltese
Manchester Terrier
Mastiff
Miniature Australian Shepherd
Miniature Bull Terrier
Miniature Pinscher
Miniature Poodle
Miniature Schnauzer
Mix Breed
Neapolitan Mastiff
Newfoundland
Norfolk Terrier
Norwegian Buhund
Norwegian Elkhound
Norwegian Lundehund
Norwich Terrier
Nova Scotia Duck Tolling Retriever
Old English Sheepdog
Otterhound
Papillon
Parson Russell Terrier
Pekingese
Pembroke Welsh Corgi
Peruvian Inca Orchid
Petit Basset Griffon Vendeen
Pharaoh Hound
Plott
Pointer
Polish Lowland Sheepdog
Pomeranian
Portuguese Podengo Pequeno
Portuguese Water Dog
Pug
Puli
Pumi
Pyrenean Shepherd
Rat Terrier
Redbone Coonhound
Rhodesian Ridgeback
Rottweiler
Russell Terrier
Saint Bernard
Saluki
Samoyed
Schipperke
Schnauzer (Standard)
Scottish Deerhound
Scottish Terrier
Sealyham Terrier
Shetland Sheepdog
Shiba Inu
Shih Tzu
Siberian Husky
Silky Terrier
Skye Terrier
Sloughi
Smooth Fox Terrier
Soft Coated Wheaten Terrier
Spinone Italiano
Staffordshire Bull Terrier
Standard Poodle
Sussex Spaniel
Swedish Vallhund
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tosa
Toy Fox Terrier
Toy Manchester Terrier
Toy Poodle
Treeing Walker Coonhound
Vizsla
Weimaraner
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier
Whippet
Wire Fox Terrier
Wirehaired Pointing Griffon
Wirehaired Vizsla
Xoloitzcuintli
Yorkshire Terrier
Zooligical Wonder
Birth Date
*
MM
DD
YYYY
Gender
*
Male
Female
Veterinarian
*
Dog's Training Needs
*
Preferred Date of the Evaluation.
*
Date Format: MM slash DD slash YYYY
Preferred Time of the Evaluation.
*
:
HH
MM
AM
PM
Is there another time that you prefer?
*
Weekends or Weekdays? Morning or Afternoon?
GENERAL AGREEMENT AND LIABILITY WAIVER
In consideration of the acceptance of this enrollment and the opportunity to participate in dog classes, private training, seminars, workshops, outings, events with Dan Roy dba Performance Dog Training LLC, I (we) agree to hold Dan Roy dba Performance Dog Training LLC harmless for 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 my (our) dog(s) while in, upon or near the premises and I (we) personally assume all liability for any such claim. I (we) further agree to hold the aforementioned parties harmless from any claim for loss of my (our) dog(s) by disappearance, theft, death, or otherwise, and from any claim for damage or injury to the dog, whether such loss, disappearance, appearance, theft, damage or injury, be caused or alleged to be caused by the negligence 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 any time resulting there from, sustained by any person or persons, including myself (ourselves) or on account of damage to property, arising out of or in consequences of my (our) participation in these classes, private training, seminars, workshops, outings, events, howsoever such injuries, death or damage may be caused or may have alleged to have been caused by negligence of the aforementioned parties or any of their employees, agents, or any other person.
Unless payment has been made in advance, payment for services rendered by Performance Dog Training LLC will be due in full, immediately following that service.
I HAVE CAREFULLY READ THIS LIABILITY, AND FULLY UNDERSTAND THE CONTENTS THEREOF. I/WE ARE AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN: MYSELF, DAN ROY DBA PERFORMANCE DOG TRAINING LLC. I SIGN IT OF MY OWN FREE WILL FOR MYSELF OR MY CHILD OR ANY INDIVIDUAL TO WHOM I AM THE GUARDIAN.
Guardian must sign for anyone under 18 years old.
SIGNATURE
*
I Agree
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