Participation Agreement/Release
Da Paws Place
19019 Roseburg St SW
Rochester, WA 98579
(360) 273-7298
Your Name: _____________________________________________________ Date:________________________________
Address: __________________________________________________City/State/Zip: __________________________________
Home phone: ______________________Cell: _________________________ E-mail address: ____________________________
Dog's Name:
Breed:
Dog's Sex:
Dog’s age
today:
I hereby agree to apply this agreement to any and all dogs I bring on the premises.
Where Da Paws Place is referenced, it shall include the owners of the property, employees, trainers, lessees, or other persons
conducting training or renting the facilities.
Do you understand that any medical condition or physical ailments that YOUR DOG might have can be aggravated by performing
any training exercises and that you are willing to accept any consequences of your decision to participate? Yes_____ No ______
(please initial) ________
(The Instructor, representing Da Paws Place, reserves the right to dismiss your dog from class until such time that a Veterinarian
examines your dog and determines him/her to be fit to perform).
Do you understand that any medical condition or physical ailments that YOU might have can be aggravated by participating in any
training exercises, and that you are willing to accept any consequences of your decision to participate? Yes_____ No ______
(please initial) ____________
Are there any prior complaints or citations pertaining to your dog(s)? Yes ____ No _____
If so, please explain.
_________________________________________________________________________________________________________
_______________________________________________________________________________________________________
Has your dog ever been classified as a dangerous dog or potentially dangerous dog? Yes ____ No _____
1) VACCINATION CERTIFICATION
A current copy of a veterinarian’s certification will be provided by me 0n request for any dog brought on to the premises by me for
the following: Distemper, Hepatitis, Para-Influenza, Parvo, Rabies (for dogs over 6 months of age) and Bordatella. If you choose not
to vaccinate your dog, you waive any liability of da paws place, instructors and participants for any disease potentially contracted at
Da Paws.
2) AGREEMENT TO RELEASE AND WAIVE LIABILITY, HOLD HARMLESS, INDEMNIFY AND ASSUME RISK OF INJURY OR
LOSS
I understand that by being on the premises of Da Paws Place, it is not without risk to me, my dog, other family members or guests,
and other class participants (human or canine). These include, without limitation, risks of physical injury, mental injury, emotional
distress, trauma, death, contact with other participants and their dogs while on the premises, and property damage. All risks are
known and assumed by me. I shall assume and pay my medical and emergency expenses in the event of injury, illness, or other in
capacity as a result of these potential injuries regardless whether I authorized such expenses. I agree that I, as owner of the above
dog(s), am solely responsible for the animal's behavior and physical control and agree to carefully monitor and control my dog at all
times.
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By reading, signing, and dating this document, I hereby waive and release the Da Paws Place, and/or owners of all premises on
which these classes are being held, and/or its employees, lessees, agents and volunteers of said owners, by agreeing not to file a
lawsuit to recover damages, losses, fines, claims, suits, expenses (including attorney fees and defense costs ), judgments, and/or
liabilities of any form or nature resulting from any act or omission, or neglect of any dog or dog owner participating in any training at
the Paws Place.
This release of liability includes, but is not limited to, any injury, death, sickness, or personal injury or property damage my pet or I
may suffer while on or around the premises where the training is held. This release also includes specifically, but without limitation
any and all forms of personal injury (including death) and property damage to me, other persons, and other animals resulting from
the act or omissions of any and all dogs or dog owners, and I expressly assume the risk of such damages or injuries and losses
throughout the duration of being on the premises.
I also agree to defend, indemnify and hold harmless Da Paws Place, its owners ( and/or the owners of all premises on which these
classes are being held, and/or the employees agents, and volunteers of said owners from any and all claims, suits, losses,
damages, expenses (including attorney fees and defense costs) judgments, fines, penalties and/or liabilities, due to any and forms
of personal injury (including death), property which my pet or I may cause, or be alleged to have caused, to any person, animal, or
property while or around on the premises before or after or where the training sessions are carried out, or in connection my
presence on the premises or with the training services provided by Da Paws Place.
I also agree to allow videos, cablecasts, or photographs or me and/or my dog for the commercial purposes without claim for
compensation, right of publicity or make no claims misappropriation.
I also agree that:
1. I have read, understand and agree to abide by the property guidelines (attachment A), and
2. I have kept a copy of this waiver for my records, and
3. My dog(s) and I are physically able to participate regardless of current medication, and
4. The instructors and owners of Da Paws Place has the authority to handle my dog as the situation dictates, and
5. My dog(s) and/or I may be dismissed from class and will forfeit any fees as a result of the dismissal, and
6. Fees for non-attendance are not refundable.
This Agreement to Release and Waive Liability, Hold Harmless, Indemnify and Assume Risk of Injury or Loss shall survive the
completion or termination of dog training services through the Da Paws Place. This agreement is an integrated agreement which
supersedes any prior, contemporaneous oral or written agreements or negotiations.
This agreement may not be modified except through a written agreement signed by both the dog owner and the owners of Da Paws
Place. This agreement need only be signed once for any activity and will be kept in the files of Da Paws Place.
By my signature below, I hereby state that I fully understand and agree to the above terms, conditions consideration for the dog
training services provided Da Paws Place.
Any liability what so ever is agreed to be limited to the cost of the training or class.
Signature: __________________________________ Date: ________________
Print your name here: __________________________________
(Must be signed by a legal parent or guardian if under 18)
Signature:__________________________________ Date:________________
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