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NAME:_______________________________________________________________________
ADDRESS:_______________________________________________________________________
CITY/ZIP/STATE:______________________________________________________________________
HOME PHONE:___________________________MESSAGE OR WORK PHONE:__________________
EMAIL ADDRESS:_____________________________________FAX:___________________________
DOG'S NAME:______________________________________________AGE:_____________________
BREED:______________________________________SEX:___________________________________
WHERE DID YOU HEAR OF THESE CLASSES?___________________________________________
Please be specific, what vet, what ad, etc.
WHAT DO YOU HOPE TO ACCOMPLISH FROM THESE CLASSES?____________________________________________________________________
HAVE YOU SHOWN BEFORE?:__________________________________________________________
PARTICIPANT WAIVER AND RELEASE
(Name}__________________________has enrolled in Handling classes with the dog (name)___________________(breed)___________. I am fully aware of the special dangers and risks inherent in this activity, including injury, death, or other consequences that may arise or result directly or indirectly from the activity. I hereby assume all risk of injury or liability. Further, I waive any right of recovery from, claim, or legal action against, and agree to hold harmless and indemnify, Georgia Hymmen, Daynakin Great Danes LLC, Daynakin Training Classes, Jack Henderson, Hyline Hotel For Dogs, Kathi Seaman and/or any of their owners or agents, class assistants or agents, property owners, or any other class participants, for personal injury, death, property or other damages, to myself, my dog, or any other person(s) associated with me, arising out of participation in the activity.
I am aware that I am responsible for the actions of my dog and will be responsible for any damage done by my dog. I understand that dangerous dogs may be asked to leave the class if the instructor deems such dogs are a possible threat to the instructor, participants, or any other person or dog. I have given my dog the required vaccines for its age; and state that he/she is free from disease at time of class.
I certify that I have read and understood the foregoing release, and that I sign this release without reservation, granting full consent and authorization for the above named person to participate in the activity. I understand that no refunds will be given after Jan. 25, 2010
______________________________________________________________________________
Signature of Participant (or Guardian if a Minor Participant) Date
Please note: Directions, motel information and schedule will be sent once your form is received.
MAIL COMPLETED FORM WITH PAYMENT TO:
GEORGIA HYMMEN
P O BOX 803
LYNDEN, WA 98264
360-380-1356 or email Daynakin@aol.com
See our site at www.DaynakinGreatDanes.com
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