Private Lessons Application Form Availability: Daytime, Evening, Weekends?Name* First Last Other AttendeesCell Phone*Alternate PhoneEmail* Address* Street Address City ZIP Code Dog Name*Breed*Age*Age in Months, Years or Weeks*MonthsYearsWeeksGender*MaleFemaleWeightSpayed/NeuteredYesNoUpload PhotoAccepted file types: jpg, gif, png.Description of Behaviors to be addressed (Please include any aggressive issues)Vet Organization NameDoctor NamePhoneWhom referred you to us?*Where did you adopt/purchase your dog from?Waiver, Assumption of Risk, and Agreement to Hold Harmless I understand that dog training is not without risk to myself, members of my family, or guests who may attend, or my dog, because some of the dogs to which I (we) will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care. I hereby waive and release Topline K9 Solutions LLC, its officers, employees, owners, members, contractors, and agents from any injury or damage resulting from the action of the dog, and I expressly assume the risk of any such damage or injury while attending any training session, or while on the training grounds or the surrounding area thereto. In consideration of and as inducement to the acceptance of my application for training I hereby agree to indemnify and hold harmless Topline K9 Solutions LLC, its officers, employees, members, contractors, and agents from any and all claims, or claims by any member of my family or any other person accompanying me to any training session or while on the grounds or surrounding area thereto as a result of any action of any dog, including my own. Terms of Service 1. The information filled out on this application is accurate and complete. 2. All owners must clean up after their dogs when out in public. 3. All dogs must remain on leash when in public. 4. Anyone under 18 training a dog must have a parent or responsible adult in attendance. By typing my name below I agree to the above terms of service.* This iframe contains the logic required to handle Ajax powered Gravity Forms.