Dog Training Registration Form Please enable JavaScript in your browser to complete this form. - Step 1 of 2We are excited you will join our family of happy dog owners! When you register and pay your fee, you grant permission to Heel Stay Play LLC to work with your dog. If your dog is attending training or being treated for behavior problems, you understand that in the area of Obedience Training, owner compliance is necessary for the dog to understand and retain the training he/she has received. You also understand that in the area of Behavioral Problems, owner compliance and patience are key in the rehabilitation of your pet. You understand that any behavioral abnormality is controllable but not necessarily curable, especially when concerning aggression problems. What is your desired Start Date / Time? *DateTimeWe will do our very best to accommodate your desired start date. Please know that due to other client schedules, we may not be able to secure the date until we confirm it.Name *Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Now let's learn about your DogDog's gender *MaleFemaleDog's AgeMy Dog is fearful of....My Dog's preferred reward....My Dog's behavioral challenges.... *BitingGrowlingAggressivenessLeash-PullingSeparation AnxietyExcessive BarkingShynessTimidHousebreakingJumping UpChewing or DiggingOtherSelect all that applyDescribe OtherList any allergies your dog hasHow long have you owned this dog?What are your goals for this training?Your Dog's Health InformationSpayed / Neutered *YesNoDog has up-to-date immunizations for.... *DHLPPBordatella (Kennel Cough)RabiesCheck all that applyName and Phone Number of your Veterinarian *Please upload a copy of immunization record * Click or drag files to this area to upload. You can upload up to 2 files. Now for the LegaleseI UNDERSTAND THAT ATTENDANCE AT A DOG TRAINING PROGRAM OR EVENT IS NOT WITHOUT RISK TO MYSELF, MEMBERS OF MY FAMILY, ANY OF MY GUEST'S WHO MAY ATTEND, OR MY DOG. I HEARBY WAIVE AND RELEASE HEEL STAY PLAY, LLC, ANY EMPLOYEES OR AGENTS, AND ASSISTANTS, FROM ANY AND ALL LIABILITY OF ANY NATURE, FOR INJURY OR DAMAGE WHICH I OR MY DOG MAY SUFFER, INCLUDING SPECIFICALLY, BUT NOT LIMITED TO, ANY INJURY OR DAMAGE RESULTING FROM THE ACTION OF ANY DOG OR USE OF, OR PRESENCE UPON PREMISES OF EQUIPMENT; AND I EXPRESSLY ASSUME THE RISK OF ANY SUCH DAMAGE OR INJURY WHILE ATTENDING ANY CLASS OR ACTIVITY OR WHILE ON THE CLASS OR ACTIVITY GROUNDS OR THE SURROUNDING AREA THERETO. IN CONSIDERATION OF AND AS INDUCEMENT TO THE ACCEPTANCE OF MY REGISTRATION FOR PARTICIPATION IN THIS PROGRAM OR ACTIVITY, I HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS HEEL STAY PLAY, LLC, THEIR EMPLOYEES, AGENTS, AND ASSISTANTS, FROM ANY AND ALL CLAIMS, OR CLAIM BY ANY MEMBER OF MY FAMILY OR OTHER PERSON ACCOMPANYING ME TO, OR MEETING ME AT, ANY CLASS OR EVENT OR WHILE ON THE CLASS OR EVENT GROUNDS OR THE SURROUNDING AREA THERETO.And finally..........I understand that any photos of my dog that are obtained during class or playgroup might be used for publicity purposes or teaching purposes by Heel Stay Play LLC. I ALSO UNDERSTAND THAT ALL DEPOSITS AND CLASS FEES ARE NON-REFUNDABLE. Client Signature *Your e-signature is consent to this registration and acknowledgment that you have read and understand the liability waiver and release form.I agree to pay (you will be invoiced) *Select via dropdownChoice 4Puppy $500Basic / Beginner $750Behavior $1000NextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit