Fargo-Moorhead Kennel Club, Inc

Canine Academy Agility REGISTRATION FORM

To register now and pay now use other link on web page.

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Phone Number (cell or home) 555-123-1212

* Email Address

Select one class. Use separate form for each dog registered.

Select only the class to which you have been assigned

* Start date of class:

* Select class. Only select one class. For other dogs please fill in sperate form.

* Breed of dog:

* Sex of dog:

* Age of dog:

* Is your pet spayed or neutered?

* Dog's name:

Age of handler if under 18:

Are you an FMKC Member? Leave blank if not.

ON BEHALF OF MYSELF, MY HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNEES; I HEREBY WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES WHICH I MAY HAVE AGAINST THE FARGO MOORHEAD KENNEL CLUB, INC., IT’S BOARD OF DIRECTORS, TRAINING DIRECTOR, AND TRAINING STAFF, AS WELL AS ANY OTHERS CONNECTED WITH THIS CLASS OR EVENT, THEIR HEIRS, EXECUTORS, ADMINISTRATORS, SUCCESSORS, AND ASSIGNEES FOR ANY AND ALL INJURIES WHICH I AND/OR ANY MEMBER OF MY FAMILY AND/OR FRIENDS, OR MY DOG MAY SUFFER OR CAUSE WHILE TAKING PART IN THIS CLASS OR EVENT OR AS A RESULT THEREOF.

PARENTS ARE RESPONSIBLE FOR THE SUPERVISION OF ANY CHILDREN IN ATTENDANCE DURING TRAINING CLASSES. CHILDREN ARE WELCOME TO ATTEND BUT MUST REMAIN SEATED IN THE SEATING AREA.

* I have read and agree with the FMKC disclaimer statement:

yes

* Your electronic signature:

You will receive a confirmation email regarding your registration.

CLASSES ARE HELD AT:

Red River Valley Fairgrounds

q ALL CLASS FEES MUST BE PAID NO LATER THAN THE SECOND WEEK OF CLASSES OR REGISTRATION WILL BE CANCELLED
Checks payable to FMKC may be brought to first class or mailed

FMKC

c/o

Marsha Susag

5302 River Drive

Fargo, ND 58102

How did you hear about the Canine Academy?

How did you obtain your pet?

I was referred to the Canine Academy by (name):

Comments:

* Indicates Response Required