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Print and Mail or Fax this Form to:
Oakland SPCA Tri Valley SPCA
8323 Baldwin Street 4651 Gleason Drive
Oakland, CA 94621 Dublin, CA 94568
Phone: 510-569-0702 925-479-9670
Fax: 510-569-1608 925-479-9680
Email: Training@eastbayspca.org
East Bay SPCA Dog Training Class Registration Form
Client Information
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Owner's Name: |
Day Phone Number: |
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Address: |
City: Zip: |
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Email Address: |
Names of other family members who will
Attend: |
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How did you hear about us? |
Dog Information
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Dog's Name |
Age: |
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Breed: |
Sex: M or F |
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Date of Last Rabies Vaccine (over 4 months): |
Date of Last DHLPP vaccine (puppies need at least 2): |
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Altered? Y or N |
From where was your dog adopted? (List other shelter or rescue group name) |
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Other classes taken? |
Class Information
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Name of Class: |
Location: Dublin or Oakland |
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Day of Class: |
Starting Date: |
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Time of Class: |
| NOTE: Class size is limited in all courses and enrollment is on a first-come, first-serve basis. Your enrollment will be confirmed via email, telephone or at the time of adoption.
Agreement
I hereby acknowledge that I have voluntarily applied to participate in dog training activities with the East Bay SPCA instructor. I am aware that there are inherent risks and hazards involved in activities with and around dogs, and I am voluntarily participating in these activities with knowledge of these potential dangers. I am not relying on the East Bays SPCA instructor or any associate of the East Bay SPCA to prevent such occurrences. In order to participate in dog training classes, demonstrations or other activities, I, being fully informed of such risks and hazards, agree to assume all risks of such occurrences. I hereby waive any and all claims or actions I or my guardians, representatives or assigns may have from any and all personal injury to myself, my dog, children in my charge, or harm to property caused directly or indirectly by acts that might occur in dog training classes or other activities.
I also agree to assume sole responsibility for injury or damage caused by myself, children in my charge, or by the dog I own or handle and further agree to indemnify, defend and hold the instructors, trainers and assistants, harmless from any damage, loss, liability or expense, including legal cost and attorney's fees, which result from damage caused by myself, children in my charge, or by the dog I own or handle.
I have read the dog training policies and I agree to adhere to them.
Owner's Signature: ________________________________________ Date: ___________
Handler Signature: ________________________________________ Date: ___________
Payment Information:
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Paid by: Check Cash VISA Amex Mastercard Discover |
Expiration Date: |
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Name on Card: |
Amount: |
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Card Number: |
All Fax and email registrations must be paid by Credit Card. Payment must be made at the time of registration.
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