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WARRENTON KENNEL CLUB
Training Class Enrollment Form

Check which class you are registering for:
7 PM ( ) Puppy Kindergarten ( ) Good Manners ( ) Show Handling
8 PM ( )Basic Obedience ( ) Novice Obedience (minimum of 5 participants to hold class)

Name:_______________________________________________________________________________
Address:_____________________________________________________________________________
City:____________________________________________ State:_____ Zip:______________
Phone: (_____) _____________ Work Phone: (_____) _____________ Cell Phone: (_____) _____________
Email address: ___________________________ Occupation:_____________________________________
Dog's Breed: _________________________________ Dog's Call Name: __________________
Dog's Age: ___________ Dog's Sex: ( ) Male ( ) Female Spayed or neutered? ( ) Yes ( ) No

Your answers to the following questions will help your instructors help you. Note: WKC trains at all levels, so some questions may not apply to you.
How long have you had the dog?_____________________________________
Does the dog live with you?__________
Where did you get the dog? ( ) Bred ( ) SPCA or Rescue Group ( ) Pet Shop ( ) Breeder ( ) Other __________________
Is this your first dog? ( ) Yes ( ) No
Do you currently have other dogs? ( ) Yes ( ) No Have you ever trained another dog? ( ) Yes ( ) No
Have you trained this dog before? ( ) Yes ( ) No Please give last class, when/where,etc. :
_______________________________________________ ________________________________________________________________________________
Have you ever worked toward an AKC Obedience title? (Yes/No) __________ With this dog? (Yes/No) __________
Titles obtained: ( ) Champion ( ) CD ( ) CDX ( ) UD ( ) TD ( ) Other ____________
Are you interested in showing this dog in: ( )Conformation ( ) Obedience ( )Now Showing
Are there problems you especially want to work on in this class, or that you hope will be corrected by training?
_____________________________________________________________________________________ _____________________________________________________________________________________

Signature: _____________________________________ Date: ___________________

You MUST send COPIES of your dog's Rabies Certificate, and Current Shot Records, along with your check for $60.00 made payable to WARRENTON KENNEL CLUB. Return to: Lynn Coppage, 12190 Richland Dr., Catharpin, VA 20143 Phone: 703-753-2404 email: lynncoppage@hotmail.com

Please sign and date the release form below. If you are a minor please have your parent or legal guardian sign the release below your signature.

RELEASE AND INDEMNIFICATION

In partial consideration of and as a condition to my exercise of the right to train my dog(s) for obedience or show handling upon The Fauquier County Fair, Inc. property, Town of Warrenton, County of Fauquier, Virginia, leased by Warrenton Kennel Club, Inc. I hereby waive, release, and discharge any and all claims for damages for personal injury or property damage which I may have, or which may subsequently accure to me against Warrenton Kennel Club, Inc. and it's members, as a result of my activities within the leased premises. This release is intended to discharge Warrenton Kennel Club, Inc. and it's members in advance from and against any and all liability arising out of or in any way connected with such activities, even though that liability may arise out of negligence or carelessness on the part of Warrenton Kennel Club, Inc. or any person or entity acting on their behalf.

PRINT NAME: _____________________________________
SIGNATURE: _____________________________________ DATE: ___________________
SIGNATURE OF PARENT/GUARDIAN (if applicable): _____________________________________