Puppy Registration Form

THANKS FOR REGISTERING FOR PUPPY CLASS. YOU WILL HAVE A PRIVATE LESSON FOLLOWED BY 5 GROUP CLASSES. ONCE I HAVE RECEIVED YOUR COMPLETED REGISTRATION, I WILL BE IN TOUCH TO SCHEDULE YOUR PRIVATE LESSON. AFTER THE PRIVATE LESSON I WILL GIVE YOU INFORMATION TO TAKE FOR THE 5 CLASSES.
Your Full Name*
Street address*
City*
State, Zip Code*
Your email address*
The best number to reach you*
Can we text you at this number?	YES NO
Your Dog's Name*
Dog's Date of Birth or Age
Dog's breed(s)
Is your dog spayed or neutered?	NO- male YES - male NO - female YES - female
Has your dog ever bitten a person or dog?	NO YES If YES, please explain below.
Is there anything you would like to tell me about your pet?:	Shy with people, allergies etc
Veterinarian's Name
Veterinarian's phone number
Vaccine Record (Please upload picture or document.)	Please upload your dog's vaccine record.
PLEASE READ THE FOLLOWING REGISTRATION AGREEMENT: COVID-19 WAIVER OF LIABILITY In this waiver of liability, the party who is requesting your signature shall be referred to as “Canine Character, LLC” Kim Yocklin, volunteers, employees, and their principles. Due to the outbreak of the novel Coronavirus (COVID-19), Canine Character, LLC is doing everything we can to protect you, our staff, and our community. To this extent, Canine Character, LLC Services will be following the Center of Disease-Control (CDC) and the Maryland Department of Health and Human Services guidance concerning social distancing practices and sanitation. We ask that our clients disclose their health history and continue to implement these sanitation and disinfection procedures. Symptoms of COVID-19 include: Fever Fatigue Cough Shortness of breath or difficulty breathing CDC’s current list of symptoms I AGREE TO THE FOLLOWING: I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days. I, nor members of my household, have not traveled internationally in the last 30 days. I, nor members of my household, have not traveled to a highly impacted area within the United States of America in the last 30 days. I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19). I, nor members of my household, have not been diagnosed with the Coronavirus (COVID-19) within the last 30 days. Canine Character, LLC cannot be held liable for any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client. If I take any steps to claim damages against Canine Character, LLC, its agents, employees, or any other released parties, I shall be obligated to pay all attorney’s fees and costs incurred as a result of such claim. Canine Character, LLC is following these enhanced procedures to prevent the spread of the Coronavirus (COVID-19) Unvaccinated clients are asked to wear surgical or cloth mask upon entering the indoor facility when coming closer than 6ft to other people. Masks are not required outside but recommended and required when coming closer than 6ft. By registering, I hereby release and agree to hold Canine Character LLC harmless from and waive on behalf of myself, my heirs, and any personal representatives any causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of the business, or that may otherwise arise in any way in connection with any services received from Canine Character, LLC. I agree to release Canine Character, LLC from any liability for the unintentional exposure or harm due to the Coronavirus (COVID-19). By registering you agree to the above.