Contact
Heart Dog Agility
Registraion


Class/Event Fun Match- Afternoon Session, first run at 4:00pm - 08/08/2010
Owner Information
*Name
*Address
*City
*State
*Zip
*Phone (include area code)

Home
*Email
Emergency Contact
Name
Relationship
Phone
Handler (If different from Owner)
Name
Phone

Register up to 3 dogs for this event.
Information for each registered dog is required
Dog #1
*Dog’s Call Name
*Breed
*Age Years Months
*Shots DHLPP(within one year) yes no      Rabies (within 3 years) yes no
Dog #2
Dog’s Call Name
Breed
Age Years Months
Shots DHLPP(within one year) yes no      Rabies (within 3 years) yes no
Dog #3
Dog’s Call Name
Breed
Age Years Months
Shots DHLPP(within one year) yes no
Rabies (within 3 years) yes no
Comments
I, my assigns and my heirs by this my directive, agree to hold harmless Heart Dog Agility, Kathleen Alles and Stan Phillips, its assigns and heirs, and any assigned instructors or assistants, from any injury or death to me or my dog or those in my charge, from loss of or injury to any personal possessions including any vehicle in my charge, from any illness or injury or damage incurred by me or to me or my dog while in attendance, participating in or observing any events, trials, practices, matches, lessons on the premises. Premises shall be defined as the 20 acres included in the Heart Dog Training Facility. I understand my dog is my responsibility to keep in control at all times, quiet, crated or on lead when not in the arena or otherwise directed for a performance or conformation venue. I also understand no vet or doctor will be present and time could be of the essence in getting me or my dog or those in attendance with me to a vet or doctor for an injury, illness, or bite and I agree to hold harmless Kathleen Alles and Stan Phillips, for any first-aid should qualified medical attention not be given timely. I understand fencing and terrain can be unpredictable and I take full responsibility for any action or inaction on my dog's or my part for any subsequent injury that might occur to me or my dog or those in attendance with me as a result of any venue held on the premises. I take full responsibility for all my actions or inactions, those of my dog, and those in my charge hereby holding Kathleen Alles and Stan Phillips, fully harmless at all times. I understand that my dog must be healthy, up-to-date on shots, rabies be current, and have flea & tick protection prior to arrival. X-pens are allowed provided my dog cannot escape, but crates are to be used when my dog is not supervised. I understand no excessive barking will be accepted. I understand that my dog must be under control at all times and liability will fall upon me for any actions or inactions resulting in injury, death, or illness. I give permission for any image taken of me to be used in any way without my previewing the image. I also state my dog(s) is/are not aggressive towards people or other dogs & that I understand I alone am responsible for the behavior of my dog(s), that any dog, which is out of control, creates an unnecessary disturbance or engages in unsafe or disruptive behavior, may at the discretion of Kathleen Alles, be expelled from the event grounds with NO REFUNDS. I am over eighteen years of age and hereby consent by my signature below to the terms of this Hold Harmless Agreement.


I agree to the above terms and conditions.

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