Class Application
Class Name: _________________________
Class Start Date: ______________________
COUNTY-WIDE DOG TRAINING CLUB, INC.
Attn: Class Registration
887 Sebastopol Road
Santa Rosa, CA 95407
Class Start Time: _____________________
Class Cost: __________________________
NAME: ______________________________________________________________
ADDRESS: ___________________________________________________________
CITY: _______________________________ STATE: _____ ZIP: _______________
PHONE (EVENING): ______________________ (DAY): ______________________
EMAIL: ______________________________________________________________
BREED OF DOG: ______________________________________________________
NAME OF DOG: _____________________________ MALE: ____
FEMALE: ____
Puppy
8 weeks / $130.
Beginning
8 weeks / $120.
Intermediate
8 weeks / $120.
Rally 1 or 2
8 weeks / $120.
All other classes are based on the
number of weeks in the session.
How did you find out about CWDTC? ____________________________________
3 Weeks
$60
Please include a copy of current vaccination records with your application.
4 Weeks
$70
AGREEMENT:
5 Weeks
$85
6 Weeks
$100.
7 Weeks
$110.
8 Weeks
$ 120.
In consideration of acceptance by County-Wide Dog Training Club, Inc., of the training of my dog, I (we) agree to hold this
club, its members, directors, officers, and any employees of the aforementioned parties, harmless 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 on the obedience training 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 (1) acts of my dog or any other dog at training class or on or near premises; (2) any injury, loss, theft, or death of
dog; (3) any acts committed by any dog in or about the training premises, whether enrolled in a training class or there as a
casual visitor in the area. And I (we) further agree that I (we) assume all liability for any action of any dog I (we) own or train
that is enrolled in this class.
For Club use only:
Owner: __________________________________ Dated: ____________________
Will the person handling this dog be 16 years or younger? YES ____ NO ____
Parent or Guardian if handler is a minor: __________________________________
June 16, 2015
Session # _____________________________
Owner # _____________________________
Dog # ________________________________
Amount Paid: _________________________