Date Recd # Cash/Check # Amount Vaccinations Rabies

LOWER BUCKS DOG TRAINING CLUB, INC.

CLASS APPLICATION

Owner(s) Name(s): ___________________________________ Home Phone: ____________________________

___________________________________ Work Phone: ____________________________

Address: ___________________________________ Cell Phone: _____________________________ City/State/Zip: ___________________________________ Dog’s Name: ____________________________ Email Address: _____________________________________ Breed of Dog: ___________________________ Handler’s Name: ___________________________________ Sex of Dog: _____ Spayed/Neutered Yes/No Handler’s Age (if under 16 yrs) ___________________________ Dog’s Age (DoB if known) _________________________ Call Training Director at (215) 493-1201. APPLICATIONS WILL NOT BE ACCEPTED WITHOUT A TRAINING INTERVIEW. Check payable to LOWER BUCKS DOG TRAINING CLUB INC. for class tuition enclosed with application. Proof of vaccinations enclosed with application. Bordetella, DHLPP (distemper, etc), and Rabies vaccinations are required. Training Director will inform you if any additional vaccinations are required during the interview. KPT (Kindergarten Puppy Training) - Puppies MUST receive a Bordetella shot and at least two DHLPP (distemper, etc) boosters before attending class. Training director will inform you if any other vaccines are required during the interview. This information is required BEFORE any dog can attend classes. PAYMENT IS NOT REFUNDABLE. REGISTRATION IS REQUIRED PRIOR TO STARTING DATE. CLASSES FILL QUICKLY! DOGS MAY NOT ATTEND CLASS IF VACCINATIONS ARE NOT CURRENT. FOR THE SAFETY OF ALL CONCERNED, DOGS DEEMED AGGRESSIVE WILL BE DISMISSED FROM THE CLASS AT THE DISCRETION OF THE TRAINING STAFF. Application for: CLASS ______________________________ DAY OF WEEK __________________ TIME ___________ If choice of day/time offered, please indicate your preference Mail to: Classes held at: LBDTC Training Site LBDTC Class Applications Leeper Shopping Center C/o Linda Morrin 8746 New Falls Road 14 Spring Court Levittown, Pa 19054 Washington Crossing, PA 18977

Lower Bucks Dog Training Club is a non-profit organization 11/15

LOWER BUCKS DOG TRAINING CLUB AGREEMENT TO INDEMNIFY, HOLD HARMLESS, RELEASE AND

WAIVER OF LIABILITY, AND ASSUMPTION OF RISK.  

I understand that attendance at a dog obedience training class is not without risk to myself, members of my family, third parties, or to my dog, even when dogs are handled with the greatest of care.

THEREFORE, in consideration of the acceptance of my application and in consideration of the benefit of attendance at dog obedience training class(es), I hereby waive, release, hold harmless, indemnify and agree to defend, the Lower Bucks Dog Training Club Inc, its Officers, Employees, Members, Trainers, Assistants, Volunteers, its Agents and/or Servants (hereinafter referred to as "the Training Club"), and the Owner(s) of the premises located at, Leeper Shopping Center, 8746 New Falls Road, Levittown, Pa 19054, its Agents, Servants and/or Employees, from any and all liability claims, damages, costs/ expenses incurred, including attorney's fees and/or causes of action/litigation arising out of injury and/or damage which I, my family, my guest, or any third party, or my dog may suffer, including, but not limited to, any injury or damage resulting from the action of any dog(s) in the training session and/or other function of the Training Club, or while on the training grounds or surrounding areas thereto.

In addition, I expressly assume the risk of such injury or damage while attending any training session, any other function of the Training Club, and/or while on the training grounds or surrounding areas. I hereby agree that the above indemnification is in addition and not in lieu of any homeowner's or general liability coverage I maintain as a condition of my participation in the dog obedience training class.

I/We, the undersigned, have read and fully understand this Agreement .

Owner(s) Signature(s):

Date:

Date: Handler's Signature:

I/We confirm that I/We have Liability Insurance *(Handler's signature also needed if he/she is not covered by the Owner's Insurance):

Owner(s) Signature(s): ________________________________________________

__________________________________________________________________

Print Name(s):

Lower Bucks Dog Training Club is a non-profit organization

Date:

10/10

LOWER BUCKS DOG TRAINING CLUB, INC. DOG PROFILE

This form must be returned with your application and check Background information is essential in understanding each dog/handler team. It enables us to provide complete overall instructions for each class. Your Name: ___________________________________________________________________________________ Dog’s Name: _______________________________________ Breed: _____________________________________ Dog’s Sex ___ Male ___ Female Dog’s Age _____ Spayed / Neutered ___Yes ___No PROBLEMS: (Check all that apply) __ Soils house __ Jumps up __ Aggressive __ Runs away __ Chews __ Shy __ Bites __ Unruly __ Disobeys __ Eats non-foods __Digs __ Barks __ Fights __ Howls __ Fears noises __ Overprotective __ Whines __ Other _____________________________________________________________________________________________ Who disciplines dog? ________________________________ How? _____________________________________ _____________________________________________________________________________________________ What is dog’s usual reaction to discipline? ___________________________________________________________ Age of dog when obtained _________________ From _____________________________________________

(Breeder, Humane Society, Newspaper ad, Pet Shop) What have you taught your dog already? ____________________________________________________________ _____________________________________________________________________________________________ What length of time do you spend training your dog per day? ____________________________________________ Is your dog on medication? __yes __no What for? _________________________________________________ Does your dog like other dogs __yes __no Are there other dogs in the house? ______________________ Has your dog bitten anyone? __yes __no What were the circumstances? ________________________________ _____________________________________________________________________________________________ What games do you play with your dog? ____________________________________________________________ Is your dog left alone for long periods? __yes __no Is your dog crate trained? __yes __no What is the highlight of your dog’s day? ____________________________________________________________ What main thing do you want out of this course? ______________________________________________________ Have you ever attended an obedience class before? __yes __no Where? _____________________________ Where did you hear about LBDTC _________________________________________________________________ Your Interests: (Check all that apply) __ Obedience Competition __ Show handling __ Therapy visits __ Club activities __ Rally __ Agility 07/12

DOG HANDLERS COPY Keep for your records

LOWER BUCKS DOG TRAINING CLUB, INC.

Requirements while you and your dog are involved in training classes with LBDTC (these may vary according to the class): • Owner(s) of the dog must have Liability Insurance (eg homeowners or general liability). • One handler per dog. • Bordetella, DHLPP (distemper, etc), and Rabies vaccinations are required. Training Director will inform

you if any additional vaccinations are required during the interview. Proof that vaccinations are current – must be submitted with your application. (Copies of vet’s bills/certificates/proof of titer are acceptable). If records are not made available BEFORE the session starts the dog will not be permitted to attend the class. NO EXCEPTIONS! If shots are administered while your dog is enrolled in a class, please bring copies of the paperwork for our records.

.KPT (Kindergarten Puppy Training) - Puppies MUST have a Bordetella shot and at least two DHLPP (distemper, etc) boosters before attending class. Training director will inform you if any other vaccines are required. We suggest seeking your vet’s approval for placing puppies in class before they’ve had all shots so that you are aware of possible health risks. Please send proof of shots to date with your application, and bring copies of subsequent records to class.

• Dogs must be at least 4 (four) months old and housebroken. Before coming to class, your dog should be well

groomed with his nails clipped. • Dogs that are ill or in season are not permitted in class – attend without dog and continue working at home. • DO NOT feed your dog for 3 hours prior to attending class. Before coming into class, allow your dog the

opportunity to relieve itself in the DESIGNATED AREA ONLY (the strip of grass between parking lot and driveway where “Visitor Parking” signs are located). It is essential that you PICK UP AFTER YOUR DOG. Thank you.

• KEEP YOUR DOG ON LEASH at all times unless you are instructed otherwise.

Enter/leave the premises with your dog on a SHORT leash.

• Bring treats for your dog – small, soft treats are best. • EQUIPMENT NEEDED:

Obedience classes 6 ft leash – leather, nylon or cotton. No Flexi-leads please Leather leashes and various types of training collars (if one is recommended) are available for purchase.

KPT 6 ft leash and buckle collar.

• Due to insurance regulations and for safety, all handlers must wear sneakers or shoes with rubber soles. No high heels, sandals, leather soles, bare feet, or foot gear determined by the instructor to be inappropriate will be permitted.

• Children under 10 years of age are not permitted on training floor. • A responsible adult must accompany children under 16 years of age at all times.

• LBDTC reserves the right to excuse any dog or handler for behavior deemed inappropriate or disruptive to the class.

• For the safety of all concerned, dogs deemed aggressive will be dismissed from the class at the discretion of

the Training Staff. • It is your responsibility to call and confirm whether or not classes are cancelled due to inclement weather • Note the day and time of class you have applied for in the space provided below.

Call Training Director at (215) 493-1201 for a training interview. APPLICATIONS WILL NOT BE ACCEPTED WITHOUT A TRAINING INTERVIEW. Please return: (a) completed application form (b) signed waiver (c) fee (d) copy of proof of

vaccinations (e) dog profile. The course fee must be paid in advance – check with Training Director for rates. No refunds will be made. A service charge will be made on all returned checks. Checks should be made payable to LOWER BUCKS DOG TRAINING CLUB INC. Send Application To: Classes Held At: LBDTC Class Applications Leeper Shopping Center C/o Linda Morrin 8746 New Falls Road 14 Spring Court Levittown, Pa 19054 Washington Crossing, PA 18977 NO PLACES ARE RESERVED – your place is NOT GUARANTEED UNTIL we have your completed application and payment If the class is full: you will be contacted and if possible an alternative class will be offered. If no space is available: your check will be destroyed. Please feel free to call should you have any questions (215) 493-1201. . Class ………………….. Day ……………………… Time …………………… Start Date ………………

11/15