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Person's name
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Address
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Phone number
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Email address
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This class is for puppies 8-16 weeks of age. If your puppy is older than 4 months, we would love to see you in Basic Manners class!
Puppy's name
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Puppy's age
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Puppy's gender
Intact female
Intact male
Spayed female
Neutered male
Puppy's breed(s) or best guess
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Who is your veterinarian?
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Date(s) of ALL distemper/parvo vaccinations
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Do you or your puppy have any food allergies? If so, please list them so that we can ensure a safe and fun experience for you and your dog. (ex. peanut butter, chicken, beef, grain, etc.)
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How did you hear about our classes? Please check all that apply.
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Adopted from Humane Society of Western Montana
Contacting or visiting the Humane Society of Western Montana
Another shelter/rescue
Veterinarian
TV commercial
Radio
Friend/family member
Website/online search
Facebook
I am a return student
Liability Release
In consideration of Humane Society of Western Montana permitting me to participate in the Group Dog Training Class (the “class”), I acknowledge that participating in the class involves inherent risks that include, but are not limited to dog bites/scratches; being knocked down/pulled over by a dog; injuries to fingers/wrist/hand from a dog leash or collar; flea/tick bites; and zoonotic illnesses (human illness contracted by animals). I am participating in the class voluntarily with knowledge of the risks (both known and unknown) and assume all risks associated with the class. I hereby waive and release Humane Society of Western Montana, its directors, officers, members, employees, contractors and agents from any and all liability and claims, arising out of or relating to the class, or any and all such liability or claims made by any member or my family or any other person accompanying me, before, during or after this class. I understand fully that Humane Society of Western Montana, it’s directors, officers, members, employees, contractors and agents accepts no liability, and I will defend, indemnify, and hold them harmless in any way regarding training, injury or damage to any person or persons or animal or animals, or to any property, however caused, which results from, in whole or in part, the training of enrolled dog, or any negligence on the part of the pet owner, or any person or persons accompanying the pet owner, and against all costs, counsel fees, expenses and/or liabilities incurred in connection with any such claim, action or proceeding. This release expresses the complete understanding of the parties and may not be modified unless mutually agreed to in writing. If any portion of it is deemed void or unenforceable, all remaining portions shall continue in full force and effect.
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I do not agree with this statement
Signature : If you agree to the Liability Release above, please type your full name here.
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Date of signature
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