REGISTER | Ultimate Companions

Join us for a Class

To register, please take the time to fill out the information below.

Other Speciality Course

First Name

Last Name

Address

Address Line 2

City

Home Phone

State

Zip Code

Mobile Phone

Dog's Name

Breed

Dog's Birthday

How did you hear about us?

Where did your dog come from?

If you are not your dog's first home, please describe history as best as you know it.

Have you trained a dog before? If so, when and where?

Does/Has your dog play (played) with other dogs. Please elaborate

What family members will be attending class?

What does your dog get for exercise on a regular basis? Do you have a fenced yard?

MEDICAL INFORMATION
Please complete this section fully or we will not be able to process your application. All dogs must be vaccinated for Distemper, Parvo and Rabies (Puppies after six months of age). Canine Cough is optional. The first Rabies shot is good for one year. Subsequent shots are good for three years.**Please either send or bring a copy of proof of vaccinations. Dogs will not be admitted without this.

Name of Veterinarian

Date of Last Distemper/Parvo

Date of Last Rabies

Date of Last Kennel Cough (if given)

Instructions:

I hereby waive and release Bill Grant/Ultimate Companions, It's employees, officers, members and agents from any and all liability of any nature for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session or any other function or while on the training grounds or the surrounding area thereto. In consideration of and as inducement to the indemnify and hold harmless Bill Grant/Ultimate Companions and it's employees, officers, members and agents from any and all claims or claims by any member of family or any other person accompanying me to any training session or function of Ultimate Companions or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

I have read the above information and understand:

Your Signature