Application for Training Classes

First Name (required)

Middle Initial

Last Name (required)

Street Address (required)

City (required)

State (required)

ZIP Code (required)

Phone (required)

Your Email (required)

Dog Name (required)

Dog Breed (required)

Dog Age (required)

Dog sex (required)
—Please choose an option—MaleFemale

Class enrolling in: (required)
—Please choose an option—S.T.A.R. PuppyBeginner Home Manners--BHMCanine Good Citizen--CGCCanine Good Citizen Advanced--CGCACanine Good Citizen Urban--CGCUBeginner Rally NoviceRally NoviceRally Intermediate/AdvancedRally ExcellentRally MasterComp Obedience 1Comp Obedience 2Comp Obedience 3Trick DogAgilityScent Work Beginner

Class enrolling in-Day of Week: (required)
—Please choose an option—MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Are you a TSKC member? (Required)
—Please choose an option—YesNo

Is dog from a rescue organization? (Required) Contact us for coupon code if this is your first class with a rescue dog.
—Please choose an option—YesNo

If yes, which rescue organization?

How will you pay for class?
—Please choose an option—online/PayPalBy mailCoupon

What was the last class you and your dog attended?

Comments or questions

Vaccinations/Titer Testing

I understand that my dog must be up-to-date on shots which includes DHPP and Rabies (must be given by a veterinarian). Bordetella may also be recommended by your veterinarian, and TSKC also recommends it. Proof of these shots or documented titer testing must be supplied prior to or the first night of class. Puppies must have age-appropriate shots with additional shot documentation supplied to TSKC as the shots are given.

Vaccination agreement? (Required)
—Please choose an option—Yes I agreeNo I do not agree

Waiver and Signature

In consideration of the acceptance of this application, the owner and handler hereby release and agrees to forever hold harmless Tri-State Kennel Club, Inc, its officers, instructors, assistants, and Board of Directors thereof, from any liability or damages or loss.

Waiver agreement? (Required)
—Please choose an option—Yes I agreeNo I do not agree

By signing hereto, I understand the terms and conditions of consideration of my enrollment and understand that my enrollment will not be accepted if I choose not to agree with these terms. This electronic signature is considered to be equivalent to a pen and ink signature for this legal document.

Signature (Required)

Date (required)

Photograph/Video Release & Authorization Form

By signing hereto, I do hereby grant and consent to Tri-State Kennel Club, Inc. (hereafter referred to as TSKC), its volunteers, representatives, successors and assigns or anyone acting on their behalf, the right to take photos or videos or use photos or videos supplied by me and hereby are given the right to reproduce, copyright, publish, circulate or otherwise use photographic material, reproductions or likenesses or videotape segments of me, my name, my dog or property. I agree that TSKC may use photographs or video of me with or without my name or name(s) of my dog(s).

This authorization and release covers the use of said material in any published form and any medium of advertising, publicity or trade in any part of the world, including but not limited to newsletters, show information and publications or catalogs, website, presentations and social media.

This agreement fully represents all terms and conditions and no other inducements, statements or promises have been made to me. I further understand by signing hereto that I will receive no monetary compensation. I waive any and all present and future compensation rights to the above stated material(s).

IN WITNESS WHEREOF, the parties hereto have caused this Photograph/Video Authorization and Release to be effective as of the day, month and year first written above.

Signature (Required)

Date (required)