Back to Classes Name _______________________________________________________________________________________
Street/PO Box/Apartment Number ______________________________________________________________
City __________________________________________________ State ____________ Zip ________________
Telephone: Home _____________________________ Office ________________________________________
E-mail _____________________________________________________________________________________
Dog: Name _____________________________ Breed ________________________________ Age _________
Class Starting Date: ______________________, 200_____
First Choice: Class _____________________________________ Day __________________ Time _________
Second Choice: Class __________________________________ Day __________________ Time _________
Number of people attending the Orientation __________ (Please do NOT bring your dog to Orientation!)
Amount Enclosed: $ ____________________I attest that my dog has had the following vaccinations on the dates indicated:
Distemper: _________ Parvo: ___________
Parainfluenza: _________ Rabies (dogs under six months exempt): _____________
I understand that attendance at a dog training facility is not without risk to myself, members of my family or guests who may attend, or my dog. I hereby waive and release Top Dog Obedience School, its instructors or agents from all liability of any nature resulting from actions of any dog while on or in the training grounds or surrounding area.
Signature: ____________________________________________
Make checks payable to Top Dog Obedience School
Mail to: Betsy Scapicchio,
124 Netcong-Flanders Road, Flanders, NJ 07836
Please bring the dog's vaccination records with you
to Orientation or to the first night of class or include a copy (not your
original) with your registration form.
Please provide your e-mail
address for confirmation of class registration. Registrations will
also be confirmed at Orientation.