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:   Ob Perf   Ag Skills   Novice Handling   Open Handling  Flatwork     Basic Rally    Int. Rally  Rally Ring-readiness

How did you hear about SCoot Dog Agility?

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, Lori Duncan, and Caroline Hunt  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 _______________ , 2009.

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.