Willow Acres Dog Training (Agility, Obedience, Herding, Clicker)

Willow Acres Farm DIXIE's Animal Training

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You may print this form by selecting "print" under the file menu. This form must be signed and dated before you may work your dogs.

DIXIE's Animal Training Release Form

Thanks for enrolling in our classes! Please indicate the class you would like to attend.

Class Name _________________ Class Time __________ Class Start Date __/__/2007

Owner	___________________________________________________________________________________
Address	___________________________________________________________________________________
City,State	___________________________________________________________________________________
Zip Code	___________________________________________________________________________________
Phone Number	___________________________________________________________________________________
Email Address	___________________________________________________________________________________

Dog's Name	________________________________	Level of Experience	_______________________
Breed	________________________________	Dog's Birthdate	_______________________

Has your dog ever bitten anyone?	________________________________________________________________
Explain	________________________________________________________________
Has your dog ever bitten another dog?	________________________________________________________________
Explain	________________________________________________________________

I understand that dog training is not without risk to myself, members of my family, or my dog. I agree that, in the event of injury to my family, my dog(s), or myself, I will not hold DIXIE's Animal Training, Willow Acres Dog Training, Jane Wittstock or Terri Wilson responsible. I also agree to assume all responsibility for any damage done to property, persons, or other dogs by me or my dog's actions.

For Herding classes & clinics only - I understand that any livestock injured while being used by me or my dog(s) must be paid for at the time of injury. This fee will be paid to the owner of the stock. ($100.00 or the vet bill, which ever is less. Minor cuts $5.00 for medication.)

My dog(s) is free of any infectious disease and is vaccinated for: Distemper, Parvovirus and Rabies.
Titers for Distemper and Parvo are acceptable in lieu of vaccinations.
****Proof of vaccination or Titer results REQUIRED and must be shown at the FIRST CLASS. ****
My dog is also free of contagious parasitic problems, whether internal or external (including fleas and ticks), and is free of any contagious skin disorder.
I understand that performance training of any type is a strenuous activity requiring my dog to be physically fit.
My veterinarian has examined my dog and agrees that my dog is in condition to perform these activities.

I have read and agree to the above statements.

Signature___________________________________________________________	Date_________________

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