Smoken Dakota Kennels Information


	Training Class Enrollment Form


			* Denotes a required field


	Handler Information


First Name*		Last Name*
Address*
Address2
City*	St*	Zip*
Phone		Email*
Cell*		Text Me	YesNo
Referral



	Dog Information


Name		Breed
Adoption Age		Age
Sex	MF	Neuter/Spay	YesNo
Class
Class Date*		Class Time*



	Where did you get your dog?
	BreederH/SPet Store
	Other


	Have you taken your dog though any type of dog classes?
	YesNo
	If yes explain


	Do you ever discipline your dog and if so how?
	YesNo


	What commands does your dog understand and perform consistently?


	What commands WOULD you like your dog to understand?


	What behavior problems would you like to discuss/resolve?


	Any prior complaints or citations pertaining to dog?
	YesNo


	Has your dog ever been classified as a dangerous dog or potentially dangerous dog?
	YesNo


	How did you hear about us?
	FacebookFlyerVetGroomerFriend/Relative/NieghborOther


	Legal


1)	VACCINATION CERTIFICATION

	By reading and signing this section of this document, I hereby certify as legal owner of the above listed dog, that this animal has received, and is current, on all vaccinations as required by law. These vaccinations include: DHPP, Rabies (for dogs over 6 months of age) and Bordatella and have provided copies prior to first session to SMOKEN DAKOTA KENNELS, LLC. Fax: 866-218-1221



Name*		Date*


2)	AGREEMENT TO RELEASE AND WAIVE LIABILITY, HOLD HARMLESS, INDEMNIFY AND ASSUME RISK OF INJURY OR LOSS

	I understand that my attendance in a dog class is not without risk to myself, my dog, other family members or guests, and other class participants (human or canine). These include, without limitation, risks of physical injury, mental injury, emotional distress, trauma, death, contact with other participants and their dogs and property damage. All risks are known and appreciated by me. I waive any and all specific notice of the existence of the risks. I shall assume and pay my medical and emergency expenses in the event of injury, illness, or other incapacity regardless of whether I authorized such expenses. I agree that I, as owner of the above dog, am solely responsible for the animal's behavior and physical control and agree to carefully monitor and control my dog at all times.

	By reading, completing, and dating this document, I hereby waive and release SMOKEN DAKOTA KENNELS, LLC, its owners and/or owners of all premises on which these classes are being held, and/or its employees, agents and volunteers of said owners, from any and all damages, losses, fines, claims, suits, expenses (including attorney fees and defense costs ), judgments, and/or liabilities of any form or nature resulting from any act or omission of any dog or dog owner participating at SMOKEN DAKOTA KENNELS, LLC. This release of liability includes, but is not limited to, any injury, death, sickness, or personal injury or property damage my pet or I may suffer while on or around the premises where the training is held. This release also includes specifically, but without limitation any and all forms of personal injury (including death) and property damage to myself, other persons, and other animals resulting from the act or omissions of any and all dogs or dog owners, and I expressly assume the risk of such damages or injuries and losses throughout the duration of the training curriculum.

	I also agree to defend, indemnify and hold harmless SMOKEN DAKOTA KENNELS, LLC, its owners, and/or the owners of all premises on which these classes are being held, and/or the employees agents , and volunteers of said owners from any and all claims , suits, losses, damages, expenses (including attorney fees and defense costs ) judgments, fines, penalties and/or liabilities, due to any and forms of personal injury (including death), property which my pet or I may cause, or be alleged to have caused, to any person, animal, or property while or around on the premises where the training sessions are carried out, or in connection with the training services provided by SMOKEN DAKOTA KENNELS, LLC. This Agreement to Release and Waive Liability, Hold Harmless, Indemnify and Assume Risk of Injury or Loss shall survive the completion or termination of dog training services through SMOKEN DAKOTA KENNELS, LLC. This agreement is an integrated agreement which supersedes any prior, contemporaneous oral or written agreements or negotiations.

	By completing the information below, I hereby state that I fully understand and agree to the above terms and conditions in consideration for the dog training services provided by SMOKEN DAKOTA KENNELS, LLC.


Date*		Name*

Training Class Enrollment Form

* Denotes a required field

***NOTE: Your form will be submitted even if you get an error page. We will receive all of your forms. Thank you for your patience.