Continuing Education Application Form K9 Training Continued Education Name* First Last Cell Phone*Alternate PhoneEmail* Address* Street Address City ZIP Code Dog Name*Breed*Age*Age in Months or Years*YearsMonthsWeeksGender*MaleFemaleWeightIn PoundsIs Your Dog Spayed/Neutered?*YesNoVet Organization NameDoctor NameVet Phone NumberI authorize Topline K9 Solutions to take my pet to the above named veterinarian for veterinary care if, in their opinion, care is needed and I will be responsible for payment for treatment. If it is an immediate emergency and my regular clinic is not open or it is a matter of life or death of the pet, I give Topline K9 Solutions the authority to take my pet to the nearest emergency clinic and I assume all financial responsibility for any bills incurred up to the amount authorized below. I also understand that Topline K9 Solutions will be released from all liability related to the treatment, expense or loss of my pet.:NoYesI authorize Topline K9 Solutions to approve treatment up to: (provide $ amount): $Is your dog up to date on all vaccines?: (Rabies, DHLPP, Etc)YesNoDate of Last Flea and Heartworm Prevention Medicine (*If fleas are found while dog is with us, we will treat the dog at the owner's expense unless directed otherwise): I authorize Topline K9 Solutions to dispense medications as directed in the Additional Notes Section:YesNoIs your dog housetrained?:YesNoIs your dog Crate Trained?YesNoHow does your dog do with other dogs? Kids?How Often Does Your Dog Eat? How much at each meal (Cups)?How Many Hours is Your Dog Typically Alone?Additional Notes For UsEx. Daily Routine, how long your dog is alone or crated, Medication dispensed, etc.Requested Start Date of Stay with Us:* Drop Off Time (Drop offs before 10 am will be charged an extra night): Drop Off Time* : HH MM AM PM Requested End Date of Stay with Us:* Pick Up Time (Pick Ups after 6 pm will be charged an extra night): Pick Up Time* : HH MM AM PM How is your dog affiliated with Topline K9 Solutions?How did you hear about our Continuing Education Program?May we have your permission to use class/consult photos and/or videos in our marketing program?YesNoUpload PhotoAccepted file types: jpg, gif, png.I understand that training is not without risk to my dog. 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, 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. If agree, please sign your name below* This iframe contains the logic required to handle Ajax powered Gravity Forms.