C&C PALS Day Training Registration Form

Start Date ___________________________________________

Owner Information

Name ___________________________________________________________

Address _________________________________________________________

City, State, Zip Code ________________________________________________

Home Phone ______________________Work/Cell (circle) Phones _____________

E-mail address_____________________________________________________

Dog Information

Dog's Name ___________________________Breed _______________________

Date of Birth__________________Breeder (if known) _______________________

Age __________Sex __________ Neutered/Spayed?________________________

Vaccination Date Information

Rabies __________ DHPP _________ Bordetella (Kennel Cough) ______________

Vet Clinic/Vet _______________________________________________________

Problems

Has your dog ever bitten a person?______ A dog?_____ If so, how many times? Person_____ Dog_____

Severity? (Scale 1 to 5) Person ______ Dog ______ (1 =>snapping at, not touching; 5 => several rips, tears or punctures)

Additional Comments _________________________________________________________________________________

Temperament

How would you describe your dog’s behavior with other dogs, i.e. aggressive, passive, rowdy, shy, etc.?

___________________________________________________________________________________________________

Goals

What are the primary areas of behavior that you would like to have worked on in this training and what are your goals from this training? ___________________________________________________________________________________________________

Do you plan on showing your dog in breed competition?____ In obedience competition?____ In other? (explain)_________

How did you hear about C&C PALS? ____________________________________________________________________

Registration

Please complete & mail the registration form, along with payment, to: C&C PALS 7790 Willow Point Dr. Falls Church, VA 22042

The form must reach us, with payment, prior to the start of the training.

Policies

• Payment for Day Training must be made in advance of the start of the first session. Prior to this, if a dog is not presently enrolled in Doptopia Day Care, the dog must first schedule an initial interview with Dogtopia to ensure that the dog can participate in day care. (This Interview incurs a fee paid directly to Dogtopia.) Upon appropriate completion of the interview the dog training sessions can be paid for to C&C PALS and scheduled.

• If you need to cancel your registration BEFORE a session starts, please do so early. It will incur a 10% processing fee. A cancellation AFTER the start of a training session series will incur a 100% cancellation fee. If a dog is dismissed from day care, C&C PALS will refund $50.00 a day for the remaining days of the unused training, and Dogtopia will refund the remaining unused day care days.

• Once a training session has started it is to be completed in the scheduled two week time frame. The exception to this is illness. If the dog becomes ill we will try to accommodate changes within limits. Under no circumstance is the time to exceed two months after the start of the original training session.

• The training sessions are non-transferable.

Release

The undersigned acknowledges and agrees that his/her participation in dog obedience training involves some risk and he/she knowingly assumes all risk attendant thereto. The undersigned does herewith disclaim and indemnify and hold harmless the officers, directors, and employees of C&C PALS, LLC from any and all loss, damage, and expense caused by reason of his/her participation in dog obedience training.

The undersigned also acknowledges that C&C PALS, LLC will not be responsible for any and all loss, damage, and expense while the dog is not directly in their care.

___________________________________Signature(s)___________________Date

We look forward to seeing you and your dog in class!