Cactus Canine Center, Inc Training Application

PLEASE NOTE: This form will print onto two sheets. Please fill out and mail with payment to;                   

Cactus Canine Center, 2555 W. Zinnia Avenue, Tucson, AZ 85705.
(Please print legibly)
HANDLER INFORMATION

How did you hear about us? ___________________________  
 
Name_____________________________________________________

Address___________________________________________________

City_______________ State_____ Zip Code__________________

Phone ______________________ Age (if under 18)___________

Work Phone (Optional) _______________________________________

Occupation (Optional) ______________________________________

E-mail Address __________________________________________                  

DOG INFORMATION

Call Name ___________________________________ Age __________

Breed _____________________________Sex _____ Male _____ Female

How long have you had this dog? _______________

Previous training on this dog? __________________________________

Have you ever owned a dog before? _____ Yes _____ No

Have you trained a dog before? _____ Yes _____ No

If so, what breed(s)?_____________________________

WHEN did you train your last dog?________________:

WHERE did you train your last dog (or WHAT organization)?_____________

Veterinarian_________________________________

Rabies ___ Yes ___ No (within 3 years)

DHLP/Parvo ___ Yes ___ No (within 1 year)

Bordetella (for kennel cough) ___ Yes ___ No (within 1 year)

What made you choose Cactus Canine Center? ____________________________________________________

Are there any particular problems you want to address in this class? What do you hope to achieve in this class?________________________________________________________________________________________

________________________________________________________________________________________

Are you interested in showing your dog in OBEDIENCE at AKC shows?          

   ___ Yes ___ No ____ Maybe

Are you interested in showing your dog in CONFORMATION at AKC shows? 

___ Yes ___ No ____ Maybe

CACTUS CANINE CENTER, INC. TRAINING AGREEMENT

 WAIVER AND ASSUMPTION OF RISK (PLEASE READ CAREFULLY)

I understand that attendance at a dog obedience training class is not without risk to myself, guests, or my dog because other dogs may be difficult to control and may cause injury even when handled with the greatest of care.

I hereby waive and release CACTUS CANINE CENTER, INC. (CCC), its employees, officers, members, and agents from any and all liability of any nature, for injury or damage, which my dog or I may suffer from the action of any dog. I expressly assume the risk of any such damage or injury while attending any training session, or any other function of CCC, or while on the training grounds or surrounding area.

In further consideration for the acceptance of my application for training membership, I hereby agree to abide by the training rules and decisions of CCC. I understand that I will not bring my dog to training sessions or to any other CCC function if it is ill, has any communicable canine disease or condition, if there is any communicable canine disease among other dogs of my household, or if my dog is not current on inoculations for Distemper/Parvo and Rabies (when of proper age). For consistency and fairness to my dog, and best results, I understand that family members should not be "training" the dog outside of class, but they may audit all of the classes.

I further agree that if I choose to discontinue the course, I will not receive the remaining handouts (lesson plans) and I am not due any money as a refund after the conclusion of the first class orientation/homework assignment.

____________________________________________________________

Signature of Applicant                 * Date                                                                  

*ONLY THE PERSON SIGNING THE APPLICATION WILL BE PERMITTED TO TRAIN IN CLASS!

Signature of Parent/Guardian, if under 18 _____________________________________

 I herewith enclose $______________ for a training course.

Class entered: _____ Novice _____ Open _____ Utility _____ Citizenship 

 Starting Date: ____________________ Instructor Preference: ________________

Paid $___________Balance due $__________  

15-foot Longe Line? _______(Required for week 1 lesson)

 _____ Cash _____ Check No. __________ Taken By: ________________________________

Visa __ Mastercard __ #__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expires _____