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How did you hear about our classes?
Where did you get your dog?
( Yes / No ) Could your dog be pregnant?
( Yes / No ) Could your dog come into heat
during or before completion of these classes?
( Yes / No ) Does your dog have any medical
conditions, injuries, etc. that could potentially
be affected by these classes?
( Yes / No ) Has your dog has never been
deemed vicious by a city or town?
( Yes / No ) Has your dog ever seriously
injured or killed a human or domestic animal?
( Yes / No ) Is the information on this form
accurate and honest to the best of your knowledge?
Liability Release
I hereby acknowledge that I will be attending
obedience classes with Heidi D'Ascoli at
the Rhode Island Society for the Prevention
of Cruelty to Animals (hereafter referred
to as the RISPCA) and in so doing I agree
to comply with all of the policies, rules,
and regulations which may be established
from time to time by Heidi D'Ascoli or by
the RISPCA. I understand that failure to
do so may result in my immediate dismissal
from class. I agree to pay for the classes
in full at the beginning of the first class
and I understand payment is not refundable
after completion of the first class.
I understand there will be other handlers
and other dogs attending these classes, that
there is a risk of injury to my dog(s) as
well any humans handling my dog(s) including
myself. I take full and complete responsibility
for any injuries that may be sustained by
or inflicted by my dog or anyone handling
my dog. On behalf of myself, my heirs, personal
representatives, and executors, I hereby
release, discharge, indemnify, and hold harmless
Heidi D'Ascoli, the RISPCA, its agents, servants,
and employees from any and all claims, causes
of action, or demands of any nature or cause,
including costs and attorney's fees incurred
by Heidi D'Ascoli, or the RISPCA in connection
with the same, based on damages or injuries
which may be incurred, or sustained by me
in any way connected with obedience classes
with Heidi D'Ascoli at the RISPCA, including
but not limited to, animal bites, scratches,
accidents, falls, and injuries to humans
or to dog(s).
_____________________________________ __________________________________
Print Name Signature
_____________________________________
Date
Please return the following to the trainer
listed below:
- This completed form
- $40 non-refundable deposit to reserve your
spot in class (checks payable to RISPCA)
- Copies of your dog(s)' current rabies vaccine,
current distemper/parvo combo vaccine, and
current kennel cough vaccine
Heidi D'Ascoli
1 Benjamin Rd
Rehoboth MA, 02969
508-868-7002
occdogtraining@comcast.net