Bella Vista Training Center

730 Mt. Airy Road

Lewisberry, PA   17339

717-432-0750              www.bvtrainingcenter.com        Email: bvwestie@ptd.net

Class Selected

Class Type:        Class Level:   

Class Dates:   

Owner Information

Name:      

Address:   

City:            State:         Zip:    

 

Daytime Phone:        

Home Phone:          

Your Dog's Vital Information

Registered Name (If any):   

Call Name:                            Sex:            Age:   

Breed:                            

Vaccination Dates:

Rabies:        DHLP:     

 

Behavior Issues:

Is your dog aggressive toward people?      If 'Yes', please describe:

 

Is your dog aggressive toward other dogs?      If 'Yes', please describe:

 

Describe your dog's previous training history (what courses has he taken & where were they?)

 

How did you learn about Bella Vista?   

 

 
                                                                                                                                                                    

 

 

Class Level:                                                                                     Class Dates:

Name of Handler:

 

Age (if under 18)

Address:

 

Home Phone:

City:

 

Work Phone:

Email:

 

 

Name of Owner:

 

 Attach a copy of your dog’s

Address:                (if different)

 

 Shot Records!

Dog's Registered Name

 

Dog's Call Name

 

Breed

 

Sex

 

Date of Birth

 

Vaccination Dates

Rabies

DHLP

Parvo

 

 

 

 

Please answer the following questions:    (If answer is "Yes" please describe the problem on reverse side)

Does your do exhibit any signs of  aggressive behavior towards people?  Y / N

Does your dog exhibit any signs of aggressive behavior towards other animals?  Y / N

Describe your dog's previous experience, including any courses taken:

How did you learn about Bella Vista Training Center?

Please briefly state what you hope to accomplish by participation in this class:

 

 

AGREEMENT TO HOLD HARMLESS, WAIVER AND ASSUMPTION OF RISK

I understand that attendance at a dog class/event is not without risk to myself, members of my family, or guest, who may attend because of some of the dogs to which I will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care.

In consideration of and as inducement to the acceptance of application for training/event entry by the Bella Vista Training Center/Bella Rose Group, I hereby agree to indemnify and hold harmless the Bella Vista Training Center/Bella Rose Group, its owners, employees, and agents from any and all liability of any nature, and from any and all claims by any member of my family or any other person accompanying me to any training session or function of the Bella Vista Training Center/Bella Rose Group for injury or damage resulting from the action of any dog, including my own, and I expressly assume the risk of such damage or injury while attending any training session or any other function of the Bella Vista Training Center/Bella Rose Group, or while on the grounds or the surrounding are thereto.

I certify that I am 18 years old or older, that I have read this entire Waiver, and that I fully understand the provisions of the Waiver and intend to be legally bound hereby.

X_________________________________________________  Date:  _______________

Signature of Owner or Authorized Agent (if handler is a minor, a Parent or Legal Guardian MUST sign).