HANDLER INFORMATION
Handler First Name:
(R)
Handler Last Name:
(R) Age:
(if under 18)
Best Way to Reach You:
SELECT
E-mail
Telephone
(R)
Best Telephone:
E-mail:
(R)
SESSION -- PAYMENT METHOD -- LIABILITY RELEASE
Session Starting Week:
SELECT
#71 - 03/08/10
#72 - 05/03/10
#73 - 07/12/10
(R)
Payment Method:
SELECT
Credit Card (next window)
Check (US Mail-Address Next Window)
Check (at class - week 7 ONLY - US mail or credit after week 7)
I am a Sirius staff member.
(R)
(Fee $140 one dog, $130 each for two or more
dogs)
Release From Liability:
Agility can be a physically strenuous and
demanding sport. Because of that, there are risks involved in
participation. Please sign the release below acknowledging that you
understand these risks. Anyone using the Sirius facility is required to
sign this release.
I understand that dog training is not
without risk to myself, members of my family, and/or my dog. I agree
that, in the event of injury to my family, my dog(s), or myself, I will
not hold Sirius Dog Agility, it owners or any of its instructors,
responsible. I also agree to assume all responsibility for any damage
done to property, persons, or other dogs by me or my dog's actions. I
hereby release Sirius Dog Agility Training Center, animal owners,
animals, property owners, instructors, spectators and or any other
participants, from any and all liability for accidents, injuries and/or
damages to me, my dog, or any property, caused by participation in any
activities including the period of time immediately prior there to, and
immediately after, the conclusion thereof, so long as the animals are
located on the premises designated for the activity. I assume all
liability for injury to myself, my dog or any property, occasioned by
this participation. This waiver shall be effective from the date of
signing.
SELECT
Agree
(R)
I agree with and accept
the conditions of the above disclaimer. By selecting "Agree", I
confirm that it has the same effect of my personal signature
agreeing to the conditions of the above disclaimer.
VACCINATIONS - ALL DOGS REGISTERED
Vaccinations:
SELECT
Yes, all dogs are current.
No, one or more dogs is not current.
(R)
I hereby certify that
each dog registered below is current
on all vaccinations.
CLASS/DOG INFORMATION #1
Dog's Call Name:
(R)
Breed:
(R)
Class:
SELECT
Mon - 7:00p - Beth
Mon - 7:00p - Laura/Carol
Mon - 8:15p - Beth/Beginner
Tue - Daytime - Susan
Tue - 7:00p - Meryl
Tue - 7:00p - Allison/Beginner2
Tue - 8:15p - Tracy
Tue - 8:15p - Kim
Wed - Daytime - Kim
Wed - 7:00p - Meryl/Lois
Wed - 8:15p - Meryl/Janelle
Thu - 7:00p - New Beginner
Thu - 7:00p - Intermediate
Thu - 8:15p - Bob/Carol
Thu - 8:15p - Karen
(R)
CLASS/DOG INFORMATION #2 - NEW OR CHANGED
DOG/CLASS
Dog's Call Name:
Breed:
Class:
SELECT
Mon - 7:00p - Beth
Mon - 7:00p - Laura/Carol
Mon - 8:15p - Beth/Beginner
Tue - Daytime - Susan
Tue - 7:00p - Meryl
Tue - 7:00p - Allison/Beginner2
Tue - 8:15p - Tracy
Tue - 8:15p - Kim
Wed - Daytime - Kim
Wed - 7:00p - Meryl/Lois
Wed - 8:15p - Meryl/Janelle
Thu - 7:00p - New Beginner
Thu - 7:00p - Intermediate
Thu - 8:15p - Bob/Carol
Thu - 8:15p - Karen
CLASS/DOG INFORMATION #3 - NEW OR CHANGED
DOG/CLASS
Dog's Call Name:
Breed:
Class:
SELECT
Mon - 7:00p - Beth
Mon - 7:00p - Laura/Carol
Mon - 8:15p - Beth/Beginner
Tue - Daytime - Susan
Tue - 7:00p - Meryl
Tue - 7:00p - Allison/Beginner2
Tue - 8:15p - Tracy
Tue - 8:15p - Kim
Wed - Daytime - Kim
Wed - 7:00p - Meryl/Lois
Wed - 8:15p - Meryl/Janelle
Thu - 7:00p - New Beginner
Thu - 7:00p - Intermediate
Thu - 8:15p - Bob/Carol
Thu - 8:15p - Karen
TOTAL DUE:
Enter the total amount due for all of your
classes. Payment options will be displayed after you "Submit
Registration"
(R)
NOTE TO SIRIUS:
Enter information needed regarding
your registration and/or payment.
NOTE:
After your registration is successfully transmitted, the
Registration Confirmation page
will open and you will process your payment based on the method you chose above.