WILDWOOD DOG TRAINING CLUB, INC.

Name of Owner:_____________________________________ Date:_______________
Name of Dog:_______________________________________ Breed:______________
Who referred you to Wildwood Dog Training Club?______________________________
THIS SECTION MUST BE FILLED OUT AND SIGNED BY YOUR VETERINARIAN:
HEALTH HISTORY
Innoculations: Date
DHL.......................... ______________________________________________________
Parvo......................... ______________________________________________________
Rabies........................ ______________________________________________________
Bordetella (Required).. ______________________________________________________
Lab Work:
Date Positive   Negative  
Heartworm Test......... ______________________________________________________
Stool Check............... ______________________________________________________
Animal Hospital__________________________________________________________
Veterinarian Signature_____________________________________________________
WAIVER

I hereby waive and release WILDWOOD DOG TRAINING CLUB, INC., it's members, instructors,
officers, and agents from any and all liability of any nature, for injury or damage which I or my
dog may suffer, including specifically, but not without limitation, any injury or damage resulting
from the action of my dog.

I hereby agree to indemnify and hold harmless this Club, it's members, instructors, officers, and
agents from any and all claims, or claims by any member of my family or any other person
accompanying me to any training session or function of the Club or while on the grounds or
the surrounding area thereto as a result of any action by any dog, including my own.

Wildwood Dog Training Club, Inc. reserves the right to revoke all training privileges of any
client whose behavior or behavior of a dog under their control is demmed to be inappropriate,
uncontrolled, aggressive or disruptive, and infringes on the safety and/or enjoyment of the
training experience of other clients and teaching staff.
  Signature of Owner or Authorized Agent_____________________________
  Date____________________________________
PLEASE RETURN THIS FORM WITH YOUR APPLICATION AND TUITION FEE,
OR BRING WITH YOU THE FIRST NIGHT OF CLASS.