DOWN HOME DOG TRAINING CLINIC LOCATION: 6761 Mercer Pike Meadville, PA 16335 DATE & TIME: Saturday September 6th, 2014 @ 3pm COST: $10 per dog per handler OR $10 to attend WITHOUT a dog

THE CLINIC WILL OFFER THE FOLLOWING: - Information about Down Home Dog Training - Basics & Foundations of Dog Training & Ownership - Sample Sessions of what DHDT has to offer (obedience, agility, scent tracking/trailing, behavioral, etc.) - NUMEROUS tips & tricks - An AWESOME giveaway & goodies!

THE CLINIC IS FOR ALL DOGS! UNTRAINED & TRAINED, ANY BREED, AGE & GENDER!

CHILDREN UNDER 17 YEARS OLD MUST HAVE A PARENT IN ATTENDANCE (PARENT DOES NOT HAVE TO PAY THE $10) PLEASE FILL OUT THE ATTACHED ENTRY FORM TO SIGN UP FOR THE CLINIC! THEN MAIL YOUR ENTRY FORM TO: HANNAH FISHER 7754 LILLY ROAD MEADVILLE, PA 16335 WITH A CHECK (MADE OUT TO: HANNAH FISHER) OR CASH FOR PAYMENT! THANK YOU! YOU WILL BE CONTACTED ONCE YOUR ENTRY FORM AND PAYMENT HAVE BEEN RECEIVED!

I am signing up for DOWN HOME DOG TRAINING’S DOG TRAINING CLINIC Owner Information Name: Location (City/Town): Email Address:

Phone Number:

Best time/day to contact you?:

Best way to contact you?:

Number of spectators in addition to the person handling the dog in the training session(s)?: Dog Information Name:

Breed:

Sex(circle one):

Male

Neutered Male

Female

Have you had this dog from a puppy? (circle one):

Spayed Female

Age:

Yes.....................No (if no, since what age?)

Did you rescue this dog?: Has your dog ever shown aggression towards other dogs? (circle one):

Yes ...................... No

If yes, please explain briefly

Has your dog ever shown aggression towards people? (circle one)

Yes ............................No

If yes, please explain briefly

Is your dog afraid of strangers? (circle one)

Yes ................................ No

I hereby apply for admission to Down Home Dog Training training classes. I understand that I am responsible for my dog’s actions at all times and Down Home Dog Training reserves the right to dismiss any dog at any given time. Furthermore, I will in case of accident, injury or illness, in any way resulting from participation in the training classes or while on the premises for any other reason, to me, my dog or my family, hold harmless from any liability Down Home Dog Training or any instructor or assistant or other persons connected in any way to Down Home Dog Training. Furthermore, I will not hold Down Home Dog Training or it’s instructors responsible for any actions of my dog(s) I _________________________________________ release Hannah Fisher (training instructor) from any and all blame of any personal injury to myself, my dog, children in my care, or harm to property caused directly or indirectly by these classes. I assume sole responsibility for injury or damage caused by myself, children in my care, or by the dog I own or handle in these classes.

By signing below, I certify that the statements contained herein are true and correct. I also certify that I am the lawful owner of the dog listed above. Signature

DATE:

Print Name

PLEASE GIVE A LITTLE MORE INFORMATION

Are any of the described behavioral problems new? (Y/N): If yes, how long have they been going on?: Is your dog on any prescriptions meds? (Y/N): If yes, tell us what they are: How much time is your dog alone each day?: Have you done any training with your dog before? What training does your dog currently have/know?:

Please choose the type(s) of behavioral problem(s) that your dog has that you would like us to work on: House Soils: Chews on things: Digging: Chases people: Chases cars: Mouthing: Jumps on people: Over barking: Bites: Bite reported: Skin broken: Stitches needed: Fights with dogs: Does not come when called: Roaming: Shyness with people: Is your dog anxious? Diet troubles: Eats stools: Car sickness: Exercise (describe what type and frequency): Other (please describe): Please provide any other significant information about your dog:

Check all that apply: 1) Why do you want to train your dog? ___ to make it a better companion ___ possible competition ___ need more control ___ other (explain: ____________________________________________________) 2) My dog… ___ is a house dog ___ stays in an outside pen or enclosure/kennel ___ stays in a fenced in yard ___ runs free unsupervised ___ stays in the basement (or other single room of house) ___ is chained or tied out ___ runs free when supervised

ALL DOGS MUST HAVE CURRENT IMMUNIZATIONS AND BE FREE OF PARASITES (INTERNAL AND EXTERNAL) PLEASE LIST UP TO 5 TOPICS THAT YOU WOULD LIKE TO DISCUSS AT THE CLINIC: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Down Home Dog Training Dog/Puppy Training Liability Waiver I hereby acknowledge that I have voluntarily agreed to participate in dog/puppy training classes at Down Home Dog Training (DHDT). I acknowledge that the dog/puppy being trained is up to date on all major vaccinations and registrations that are available for it. I am aware that there are inherent risks and hazards involved in activities with and around dogs, and I am voluntarily participating in these activities with knowledge of these potential dangers. I am aware that any dog, regardless of training, handling, breed, age, environment, or any other circumstance, is capable of biting and I expressly acknowledge the risks therein. In addition, there may be a potential for slips/falls/injury/escape from a training area during DHDT’s training classes. In order to participate in dog/puppy training classes or other activities, I, being fully informed of such risks and hazards, agree to assume all risks of such circumstances. I hereby waive any and all claims or actions that I or my guardians, heirs or legal representatives may have, from any and all personal injury to myself, my dog(s), children or other persons in my charge, or harm to a person, people, or property caused directly or indirectly, through action or inaction of myself or others, by acts that might occur in and during dog training classes or secondary training, outside of training classes, without the training instructor present. I agree to indemnify DHDT and its owners and employees from any and all claims by myself, my family members, or any guest, friend, or agent of mine, while within training facilities, within my home property, or in the general public as a result of any action or inaction, of either my dog or any other dog now and in the future. I also agree to assume sole responsibility for injury or damage caused by myself, by the dog(s) I own or handle, or children in my charge, and further agree to indemnify, defend and hold DHDT, its trainer(s), owners and other employees, harmless from any damage, loss, liability or expense, including legal cost and attorney’s fees which result from damage caused by myself, children in my charge, or by the dog I own or handle. DHDT may use pictures of me or my dog for promotional purposes without liability or obligation of any kind to me. I have read the Dog Training Liability Waiver and agree to adhere to the above policies.

Dog Owner Signature: ___________________________________________ Date: __________ Printed Name ______________________________________________________