Name: ______________________________________________________________________________________

Other Handlers: _______________________________________________________________________________________________________
                                    Please list all people that will work with your dog in class

Address: ____________________________________________________________________________________
                                                (Street)

____________________________________________________________________________________________
                                                (City)                                                                             (State)                                                                     (Zip)

Phone: Home ____________________________                 Work ____________________________________

E-mail Address: ______________________________________________________________________________

Dog’s Name: __________________________      Breed: ______________________     Age: ______________
                                                                                                                                    (Birthdate for puppies)

Has your dog ever bitten a person? ____yes ____no

Has your dog started a fight with another dog? ____yes ____no

Does your dog lunge and bark when it sees other dogs? ____yes ____no

Does your dog have any difficulty meeting people or dogs? ____yes ____no

If you answered yes to any of he questions above, please describe circumstances:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Dogs that behave aggressively (lunge-barking, charging) to other dogs are not permitted in agility or flyball. Dogs that are easily
aroused by activity of other dogs should not participate in agility or flyball. Dogs meeting these descriptions may be permitted in
obedience on a case-by-case basis. If you are unsure whether a class is appropriate for your dog, please call the Mad City Dog
Training office to schedule a behavior consult or a class evaluation.

Class sizes are limited and will be assigned in the order which registrations and payments are received. An acknowledgement
will be sent to confirm your enrollment.

I, the undersigned, accept full responsibility for the acts of my dog, my guests, and myself before, during, and after classes; and
release Mad City Dog Training LLC from any and all claims of liability.

Signature __________________________________________________________________         Date ______________________