Registration Form Please sign and complete this form after you have made a payment. This form is required in our hands by the first class (you can scan and email to us, or print and bring to the first class) as well as proof of up to date vaccinations from your vet (a hard copy of letter or detailed receipt that we can keep).

Course Requested Start Date & Time

Human Student’s Name(s) How did you hear about us?

Address City State Zip

Phone please include all numbers necessary to reach you Email

Children names & ages of all that will be attending with you

Are there any special needs of any attendees that we should be aware of? Please specify:

Dog’s Name Breed Age Birthday Gender Spayed/Neutered?

Brief background on how long you have had, where adopted, allergies, health concerns, etc. :

Veterinary Information

Bark n’ Roll ~ mailing address: PO Box 524, North Reading, MA 01864 p: 978.604.2949 e: [email protected] w: bark-n-roll.com Goals of taking this course please list any problem behaviors :

Prior Training Experience? If yes, where and what philosophy was used?

Vaccinations: Bark n’ Roll follows the American Veterinary Society of Animal Behavior’s Position Statement on Socialization: “In general, can start puppy socialization classes as early as 7-8 weeks of age. Puppies should receive a minimum of one set of vaccines at least 7 days prior to the first class and a first deworming. They should be kept up-to-date on vaccines throughout the class.” Please refer to the AVSAB website at www.AVSABonline. org for full statement and more information on puppy socialization. Adult must have proof of an up to date vaccine as well as the Distemper combo. The Bordatella (kennel cough) vaccine is not required by BnR. Please inform your veterinarian that you will be attending group classes and follow his or her advise regarding this vaccine for your dog.

Date of Last Inoculation: Distemper/Parvovirus Rabies

TRAINING AGREEMENT Bark n’ Roll hereinafter known as “the Company” cannot make any guarantee regarding the outcome of any training/counseling program. The student assumes full responsibility for the dog’s behavior during and after the training/counseling program. The student may have the animal withdrawn from training at any time, however, once payment has been made, all fees are non-refundable. The student is required to work the dog(s) 7 to 12 times a week on strengthening all cues taught. The reinforcement can be accomplished in approximately 20 to 30 minutes per day per dog.

THE STUDENT UNDERSTANDS AND AGREES THAT THEY ARE BEING TRAINED TO TRAIN THEIR DOG(S) AND THAT WITHOUT 100% COOPERATION WITH THE TRAIN:ER, THE DOG(S) WILL NOT GET TRAINED.

MAKE UP LESSONS The student may make up a missed lesson within 6 months of the start date of the course free of charge by join- ing that same class when offered with a different group (most likely this will require you to complete the course out of order). Please note that attendance of the first class is MANDATORY. Regular private training rates apply for those requiring a private make up lesson.

LIABILITY My signature below indicates that I, as the legal owner/agent of the abovementioned (s), having carefully read and fully understand this agreement, do hereby waive and release the Company/Francine Coughlin and its associates from any and all liability of any nature. This includes any injury, death, sickness or damage my pet may suffer during or after any training program. I also agree to indemnify and hold harmless the Company/ Francine Coughlin and its associates from any and all claims due to damage the pet may cause to any family members, or property of any third parties during or after training. I HAVE READ AND UNDERSTAND THAT ALL TRAINING IS CONTINGENT UPON THE STUDENT’S WILLINGNESS TO HANDLE AND / OR WORK THE DOG(S) AS DESCRIBED ABOVE.

Student’s Signature Date

Bark n’ Roll ~ mailing address: PO Box 524, North Reading, MA 01864 p: 978.604.2949 e: [email protected] w: bark-n-roll.com