Pet Therapy Class Name* First Last Other Class Attendees:Cell Phone*Alternate PhoneEmail* Address* Street Address City ZIP Code Dog Name*Breed*Age*Age in Months or Years*YearsMonthsWeeksGender*MaleFemaleWeightin PoundsSpayed/Neutered*YesNoDescription of Behaviors to be addressed and your goals for your dog.Vet Organization NameDoctor NamePhoneHow did you hear about our services?Where did you purchase/adopt your dog from?May We Use Photos for Facebook/Marketing?YesNoUpload PhotoAccepted file types: jpg, gif, png.Pet Therapy Class Date & LocationPT, Raleigh Community Animal Hospital, Raleigh - Tuesday, Oct 23 at 6:30PMWaiver, Assumption of Risk, and Agreement to Hold Harmless I understand that attendance at a dog training class 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. Refund Policy Because we keep our classes small, we are unable to issue refunds or class credits. Terms of Service 1. The information filled out on the class application is accurate and complete. 2. All owners must clean up after their dogs when on the premises of the facility. 3. All dogs must remain on leash when on the premises of the facility. 4. Any dog which, in the opinion of the class instructor, is aggressive will be removed from the class. 5. Anyone under 18 training a dog in class must have a parent or responsible adult in attendance during class. 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.