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 Flyball Application
You may print out this form by clickin here.

Owner Name
Home Phone
Cell Phone
Other Phone
Email
Address
City
State
Zip Code
Emergency Contact Other Than Yourself
Phone
Pet Name
Gender
Male Female
Spayed/Neutered
Yes No
Date Of Birth
Breed
Color
Veterinarian
Vet Phone Number
Date of last Rabies Vac -
Date of last DHLPP Vac - 
Date of last Bordetella Vac -
Does your dog have aggressive behavior towards people/other dogs?
Yes No

Does your dog have issues or concerns we need to know about such as, but not limited to, fear biter, separation anxiety, dog aggressive, lacks recall, overly excitable? (Please circle the above or list below):


What are your goals in flyball?
Are you interested competing and racing on a team? (Keep in mind most races are in the Twin Cities area):
Which day do you prefer: Tues. or Wed.?
Any additional information we need to know about:



PLEASE READ AND SIGN WAIVER BELOW!

                
Waiver of Liability & Informed Consent Release
 
I, the undersigned, have enrolled myself and my dog(s) in dog training classes, private consultations, workshops or other related activities (Classes) offered by Angie's Groom 'n Board. By signing hereunder, I certify that I have been informed and understand that there is always some unavoidable risk of injury involved when working with animals, especially animals with behavioral issues. I acknowledge that dogs can be inherently difficult to control and that not all dogs will be under control at all times resulting in the possibility of injury to myself, my dog, my family members, or third parties. Additionally, I have had full opportunity to discuss all concerns I have about the foregoing risks with Angie's Groom 'n Board and its authorized representatives. I have also made all inquiries and investigations to my satisfaction related to such risks, including, but not limited to, an examination of the training area (if applicable).

 

I hereby accept and assume, without reservation, all risks associated with my participation in the Classes, including, but not limited to: the risks of any and all injuries to myself, my dog and any of my family members or third parties who may attend; the risks that my dog may cause injury to other persons and/or dogs involved in the Classes; and the risks that saliva, water, food, snow and/or other debris may be present in the training area.

 

 As lawful consideration for participating in the classes, I, for myself, my heirs, executors, administrators, legal representatives, successors and assigns (the “Releasing Party”), hereby waive, release, discharge and agree not to sue and to indemnify, defend and hold harmless Angie's Groom 'n Board and their members, managers, agents, and employees (the “Released Party”) from any and all injuries, losses, claims and damages to any person or persons of any nature whatsoever, including claims arising from the Released Party’s own negligence, and all costs associated therewith, including attorney’s fees, court costs and consultant fees, arising from my participation in the Classes.

This Waiver of Liability & Informed Consent Release shall be legally binding on the Releasing Party. Should the Releasing Party assert a claim to the contrary to what I have agreed to in this Waiver of Liability and Informed Consent Release, the claiming party shall be liable for all expenses (including attorney’s fees, court costs and consultant fees) incurred by both the Releasing Party and the Released Party. No waiver or modification of any provision herein shall be valid unless expressly agreed to in writing by both the Released Party and the Releasing Party.

I hereby consent to my dog being the subject of the photographs and/or audiovisual recording and authorize Angie's Groom 'n Board to cause the same to be exhibited for educational purposes as still photographs, transparencies, motion pictures, television, video or other similar media. I hereby release Angie's Groom 'n Board from any and all claims for damages for libel, slander, invasion of privacy or any other claim based on use of the above-described material(s).

Every provision herein is intended to be severable. If any one or more of the provisions herein is found to be unenforceable or invalid, that shall not affect the other terms and provisions hereof, which shall remain binding and enforceable.

I represent that I am at least 18 years of age.

angiesgnb@arvig.net * Angie's Groom 'n Board*

Having read all of the above, I hereby agree by my signature below (whether "electronic" or physically written):
Signature and Date



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