Owner Name: ____________________________________________

Street Address: ___________________________________________

City & Zip Code: __________________________________________

Email Address: ____________________________________________

Phone #: Day ___________________ Evening: ___________________

Dog’s Name: ______________________Breed: __________________

Spayed or Neutered:    Y   N                            Age: _______________

Veterinarian/phone #: _______________________________________

Class:  Basic Agility     Beyond Basic   Novice Handling   Masters Handling    Gamblers

Please tell us any important information, concerns, or comments about your dog (including aggression or reactivity issues):

Please tell us about your training goals and expectations for agility:

By submitting this form I(we), agree that as consideration for me and enjoyment of the agility lessons and facilities, I(we) hereby release SCoot Dog Agility, John Reid, and Lori Duncan from any claims of damage or liability including attorney’s fees, medical payments, property damage, or bodily injury damages.  I(We) also agree that we are assuming the risk of participating in training where there are other dogs whose temperament is unknown to me; that I(we) assume full responsibility for any injury that may occur to us, to our dog or dogs, other property, or any damage that would ordinarily be due us, that we waive any right that we may have to institute any suit or other proceedings to recover therefore.

Signed this ____ day of _______________ , 2008.

Signature of participant (s) __________________________

Print name (s)  ______________________________________
Mail with check payable to SCoot Dog Agility to Lori Duncan, 814 West Madison Ave., James Island, SC 29412.