Clever K9 Obedience w/ Ann Marie Scripko
Agility Registration and Release form
Name:__________________________________________________________________
Address:________________________________________________________________
City, State, Zip:__________________________________________________________
Phone:__________________________Email:__________________________________
Dog’s Call Name:________________________________________________________
Dog’ Breed:_____________________________________________________________
Dog’s Age:_________________Has your dog ever bitten anyone?:________________
IF yes, please explain:_____________________________________________________
Vaccines or Titer current?:____________________
Has this dog ever taking Obedience/Agility classes:____________________________
IF yes, Where and what levels:_____________________________________________
CLASS INFORMATION : Cost $125 for 6 One hour classes
Mondays Outdoors in Jackson Adv. Beginner agility 9am (limit 8)
Wednesday Outdoors in Jackson Beginner Agility II 7pm (limit 8), Beginner
Agility I 8pm
Thursdays Outdoors in Jackson Adv Beginner I 5pm , Adv. Beginner Agility II
6pm ( limit 8) Open 7pm (limit 8) Novice 8:30pm (limit of 8)
Class:_________________________________________________________________
Dog’s Name:____________________________ Class Time:____________________
Class:__________________________________________________________________
Dog’s Name:____________________________ Class Time:____________________
Class:__________________________________________________________________
Dog’s Name:____________________________ Class Time:____________________
Make checks payable to CleverK9 Dog Obedience or Ann Marie Scripko. Mail or hand
to Ann Marie Scripko 279 Jackson Pines Road, Jackson NJ 08527. Contact Ann with
questions at cleverk9@optonline.net or 732-901-4166
All classes must pre-register, No spots will be held without payment.. If there are not
enough dogs to fill a class, you will be given the option of a refund or move to a
different class. There are no refunds once the first class begins. If classes are
canceled by Ann due to bad weather etc. there will be a makeup class, no refunds.. If
you miss a class, for any reason, you can make up the class by attending another class
of similar level your dog is working at. There are no refunds or private lessons to
makeup for classes you miss..
You must fill out the release form on the back of this form.
Clever K9 Obedience Release Form
I, ______________________________________, understand that attendance of a dog
training session is not without risk to myself, members of my family or guests who may
attend, or my dog, because some of the dogs to which I (we) will be exposed may be
difficult to control and may be the cause of injury even when handled with the greatest
amount of care. I understand that the use of dog training equipment and the use of the
Training facility are not without risk to myself, members of my family or guests who may
attend, or my dog, because dog training requires physical movement on both my and the
dog’s part.
I hereby waive and release the property owners, Joe Mosner and Golden Grange Kennels,
Ann Marie Scripko, Michael Scripko and Clever K9 Obedience, and any instructors, or
employees or family members from any and all liability of any nature or damage which
my family, guests, I or my dog may suffer, including specifically, but not without
limitation, any injury, or damage resulting from the action of any dog or use of
equipment.
I expressly assume the risk of any such damage or injury while attending training
sessions, or while on the training grounds or the surrounding area thereto. In
consideration of and as inducement to the acceptance of my application for training at
this facility, I hereby agree to indemnify and hold harmless the property owners, Joe
Mosner and Golden Grange Kennels , Ann Marie Scripko, Michael Scripko and Clever
K9 Obedience, and any instructors, or employees or family members from any and all
claims, loss and expenses , including legal fees, or claims by any member of my family
or any other person accompanying me to any training session, by reason of liability
imposed by law upon the aforementioned party for the damage because of bodily injuries
at any time resulting there from, sustained by the aforementioned party or may be alleged
to have caused by negligence of the aforementioned party or any of the person.
Signature:_____________________________________________
(or signature of legal Guardian if handler is under the age of 18)
Print Name:___________________________________________
Date:_________________________________________________
New Bad Weather Policy
Because of the large number of students to contact for classes ... I will no
longer be able to call with class cancellations. If class is cancelled due to
weather conditions, I will post an email to the Clever K9 Yahoo group only by
approximately 4pm Mondays and Thursdays. I will not email directly to
each email, I will not be able to call individually . Please make sure you join
the group or call. I will also post a message on my Answering machine if
classes are cancelled. This will be posted by approximately 4pm. Class
status will also be posted on the website.
It will be your responsibility to check your email and call 732-901-4166
to check on the status of class during bad weather. Remember if
weather seems questionable, to check. Decisions will be based on The
conditions at Golden Grange, Agility ring in Jackson and the surrounding
Central Jersey area. This can be very different from where you live. Please
make a habit of checking before you leave.
Typical Guidelines:
Outdoors in Jackson
-no class if Below 32 degrees
-no class if over 90 or heat index is over 90
-no class if snow or ice on ground
-no class if Thunder and lightening. (light rain, still have class)
Indoors at Golden Grange
-no class if road conditions or building conditions are not safe due to snow,
ice, or severe thunderstorms
Thank you and feel free to contact me with any questions or if you need an
application sent to you.
Ann
cleverk9@optonline.net 732-901-4166 or my cell 848-525-8298
To Join the Yahoo Group go to: http://pets.groups.yahoo.com/group/cleverk9dogtraining/