Treasure Coast Kennel Club of Florida, Inc
Beginners Agility Registration Form

Please Print Clearly

Name of Owner: _____________________________________________________________________
Name of Person Training Dog: _________________________________________________________
Email: _____________________________________________________________________________
Address: ________________________________ City: ________________________ Zip: ___________
Phone: Daytime: ____________________ Evenings: ______________________________________
Call Name of Dog: ________________ Breed: ______________________Sex: ____ Age: _______
State briefly any problems you are having with your dog: __________________________________
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What do you want to accomplish? ___________________________________________________________
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Do you have any physical problems or disabilities, which may affect his/her training? ______________
_________________________________________________________________________________________

How did you hear about our classes? _______________________________________________________


Waiver: (Assumption of Risk and Agreement to Hold Harmless)
I understand that attendance of a dog obedience training class is not without risk to myself, members of my family, guests who may attend, or my dog, because some of the dogs which I (we) will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. I hereby waive an release the Treasure Coast Kennel Club of Florida, Inc., its members, instructors, assistants, and board of directors from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not without limitation, any injury or damage resulting from the action of any attending any training session or function of the club, or while on the training grounds or the surrounding area thereto. In consideration of an as inducement to the acceptance of any application for training in this obedience training class, I hereby agree to indemnify and hold harmless this club, its members, instructors, assistants, and Board of Directors from any and all claims, or any claims by any member of my family or any other person accompanying me to any training session or function of this Club or while on the grounds of the surrounding area as a result of any action by any dog, including my own. TCKC’s Refund Policy– No refunds after orientation! Dogs must be current with shots.
I have read, understand, and agree to abide by TCKC’s Aggressive Dog Policy.

Signature of Owner or Authorized Agent (In case of minor, a parent or legal guardian must sign)

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Date:_________________________