Angie’s Agility Registration Form

Your Contact Information

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Class Selection: Angie's Agility Class, Wed May 16 - June 20, 9:30am

Your Dog

Dog's Sex *
Intact MaleNeutered MaleIntact FemaleSpayed Female

Background Information

What would you like to learn in this class? *

Has this dog attended training classes before? *NoYes, at Joyful Dog LLCYes, elsewhere

If yes, what class(es) did your dog attend and who was the trainer?

Are you familiar with clicker training?
YesNo

Have you owned other dogs in the past?
YesNo

If so, what training approaches did you use?

Do you have any concerns about your dog's behavior around other dogs, children, or strangers?

How does your dog behave at home? *

How does your dog behave in the outside world? * Please explain.

Has your dog ever bitten or been bitten? *YesNo If yes, please explain circumstance(s).

Does your dog play with other dogs? *YesNo If yes, where?

Does your dog guard food, toys, or other objects? *YesNo If yes, please explain.

Does your dog act fearful or aggressive toward:*
ChildrenMenDogsOther AnimalsLoud NoisesThunderstormsVehiclesOtherIf yes, please explain.Is there anything else you'd like the instructor to know?

Name & Location of Vet *

Date of last DHPP (Distemper, Hepatits, Parvovirus, Parainfluenza) vaccine: *

Date of last Rabies vaccine (for dogs 4 months or older): *

Date of last Bordetella (kennel cough) vaccine: *

If you use titers, date of last titer: *

I understand that my dog must be free of contagious conditions, parasites (including fleas), and have an annual stool check. *YesNo

Accident Waiver and Release of Liability

In exchange for being allowed to participate as a student in the Agility Training Group Class (the “Class”) offered by Joyful Dog LLC, a Virginia limited liability company (“Joyful Dog”), which will be held at 12001 Thomas Ave., Great Falls, VA 22066 (the “Property”), which is the residence of Angela Boyer (“Owner”), the undersigned participant (the “Participant”) represents, warrants and agrees as follows:

This Accident Waiver and Release of Liability (this “Release”) is given voluntarily by me for valuable consideration received, on behalf of myself and my: children, spouse, heirs and next-of-kin, trustees, creditors, executors, successors, assigns and representatives (collectively and including the undersigned Participant, referred to for convenience and breadth as the “Releasors”), to the maximum extent permitted by applicable law. The Releasors hereby assume all of the risks of being on the Property and participating in the Class, including without limitation any risks that may arise from negligence or carelessness on the part of any persons. To the maximum extent permitted by applicable law, the Releasors hereby: (1) WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for the death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to any of the Releasors named herein, including my traveling to and from the Property or the activities thereon, the following entities and persons: (a) Joyful Dog LLC and its owners, managers, employees, contractors and agents; (b) Owner; and (c) their respective heirs and next-of-kin, assigns, creditors, successors and representatives (collectively referred to herein for convenience and breadth as the “Releasees”); and (2) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the Releasees from any and all liabilities, damages, losses or claims made as a result of participating in the Class or being on the Property for reasons related to the Class, whether caused by the negligence of any Releasee or otherwise. THE UNDERSIGNED PARTICIPANT CERTIFIES THAT HE/SHE HAS READ THIS DOCUMENT, FULLY UNDERSTANDS ITS CONTENT, AND PROVIDES IT VOLUNTARILY ON BEHALF OF THE UNDERSIGNED AND ALL OTHER RELEASORS. If any Releasee must enforce this Release, he/she/it shall be entitled to an award of attorneys’ fees and costs incurred in defense of this Release or the claims intended to be released hereunder. You agree and understand that by signing this Release in an electronic format, including by typing your name in an e-mail and/or clicking to agree and submitting this form, that (a) such action constitutes an electronic signature governed by The Electronic Signatures in Global and National Commerce Act, and VA Code §§59.1-467-469, (b) any such signature shall bind you as if such signature were made on paper in your own handwriting, and (c) you consent to these terms and agree that these arrangements are fair and reasonable, and that you are entering into this Agreement voluntarily and with a full understanding of its terms.

By checking this box, the Participant signing below agrees to be bound to the terms and conditions set forth above:*

Participant Signature *

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To submit your information, please hit send. If you do not receive confirmation the form has been sent, scroll up to make sure all required fields have been entered. Once you've submitted your form successfully, pay online via our Square store at:

https://squareup.com/market/joyful-dog-llc

or send a check to:

Joyful Dog LLC
PO Box 6454
Leesburg, VA 20178