Account • The Well-Mannered Dog, LLC/ Dog training/ Puppy Classes/ eugene oregon/positive reinforcement/behavior/obedience

Your application is a legal contract and therefore, must be filled out by an adult.

Has This Dog Been Registered In A Class This Year?*

Yes
No

Pick your first class

Great Start Puppy Class
Serious Self Control
Adventure Ready Dog 1
Adventure Ready Dog 2

Indicate the Date you wish to have your first class

MM

DD

YYYY

Please pick your start date wisely. This can not change once you enroll.

Your Information

Name of the PRIMARY ADULT who will do the training*

First Last

Name of other Adults who will attend with you

Street Address Of the Primary person training:*

Street Address City State / Province / Region ZIP / Postal Code

Email Address of the Primary Person training*

Phone Number of primary person training:*

Note any changes to your contact information here

Your Dog's Information

Name of the dog you are enrolling*

Your Dog's Primary Breed*

Your Dog's Secondary Breed if any

Your Dog's Birthdate (or approximate)*

Your Dog's Sexual Status*

Intact Female
Spayed Female
Intact Male
Neutered Male

Due Date for next set of vaccines (Distemper / Parvo):*

MM

DD

YYYY

What Local Veterinary office are you presently using?:*

Please list the skills you would like your dog to gain*

Note here if your dog's has been spayed or neutered or any behavioral changes since your last enrollment

Miscellaneous Information

Is there any additional information about your dog you would like me to know?:

How did you find out about our training?:*

What other local training have you attended:*

What made your decide to get professional help?*

What attracted you to enroll with us compared to other places you looked at:*

Are you interested in any dog sports?:*

Class qualifications

I certify, my dog is in good health, free of contagious diseases and up to date on all age-appropriate vaccines. Should my dog become ill, I agree to come to class without it.*

Yes
No

I believe my dog will not vocalize (bark, whine) repeatedly. If starts vocalizing, I can get it to be quiet with the use of treats or dog chews. Should an issue be discovered, I agree to transfer to a more appropriate program.*

Yes
No

I believe, my dog can either walk or be carried down the stairs leading into the training room. Should an issue be discovered, I agree to transfer to a more appropriate program.*

Yes
No

I believe my dog will be relaxed enough to eat treats. Should an issue be discovered, I agree to transfer to a more appropriate program.*

Yes
No

I believe my dog will not threaten other dogs or people with unfriendly behaviors (unfriendly barking, growling, lunging, snapping or biting.) Should an issue be discovered, I agree to transfer to a more appropriate program.*

Yes
No

I state, I have ability to handle my dog in a way that ensures the safety of other dogs and people. Should an issue be discovered, I agree to transfer to a more appropriate program.*

Yes
No

I state, I can hear instructions even if the instructor is 30 feet away. Should an issue be discovered, I agree to transfer to a more appropriate program.*

Yes
No

I state, I can safely walk my dog down the stairs leading to the training room. Should an issue be discovered, I agree to transfer to a more appropriate program.*

Yes
No

Agreements and Policies

I still agree to all agreements and policies from my previous registration.

Yes
No

I agree to not allow my dog to get close to other dogs in class without our instructors permission.*

Yes
No

I promise to keep my dog up to date on its vaccines while it attends training.*

Yes
No

I agree to stay home from class if I have symptoms of a contagious disease (a cough, fever, shortness of breath, digestive upset) or if I am exposed to a person who is contagious.*

Yes
No

I agree to follow all social distance guidelines, and to keep my mouth and nose covered at all times and stay at least 6 feet apart, etc.*

Yes
No

Should my instructor become contagious, or a Stay At Home Order be issued, I agree to have my classes online until those conditions are rectified.*

Yes
No

I grant The Well-Mannered Dog permission to use and reproduce my and my dog’s likeness, voice, name, images in any and all audio, written or visual format to be used in the education of others and marketing. I hereby relinquish, give and assign to The Well-Mannered Dog, LLC all rights, title, and interest I may have in the materials without limitation. In addition, I acknowledge The Well-Mannered Dog is the owner of said materials without payment or compensation to me.*

Yes
No

Cancellations & refund policy - I understand that upon submitting my payment work has begun on my behalf and I will have access to the orientation within 24 hours. Therefore, no refunds will be given. I understand if I need to withdraw from training due to illness or injury of myself or my dog, I can present a doctors note to get 100% credit of my unattended classes credited to my account and that it needs to be used within 60 days.*

Yes
No

I agree to forfeit any classes that are not used prior to the expiration period.*

Yes
No

I understand if I need to withdraw from training due to illness or injury of myself or my dog, I can present a doctors note to get 100% credit of my unattended classes credited to my account and that it needs to be used within 60 days.*

Yes
No

Hold Harmless Waiver - Submitting your application, signifies your agree to our Agreement To Hold Harmless, Waiver And Assumption Of Risk waiver. Agreement To Hold Harmless, Waiver And Assumption Of Risk – I understand that attendance of a dog training class is not without risk to myself, members of my family, guests who may attend, or my dog, because some of the dogs to which I 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 THE WELL-MANNERED DOG, LLC hereinafter referred to as the Training Organization, its employees, officers, members and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session, or any other function, of the Training Organization, 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 membership by this Training Organization, I hereby agree to indemnify and hold harmless this Training Organization, its employees, officers, members and agents from any and all claim, or claims by any member of any family or any other person accompanying me to my training session or function to the Training Organization, or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.*

I agree
I do not agree

Product Name*

Pay for 10 weeks of classes but get 11 - 12 week expiration period - $258
Pay for 15 weeks of classes but get 17 - 19 week expiration period - $387
Pay for 5 Consecutively scheduled classes - 5 week Expiration period - $129

Credit Card*

Card Details

Cardholder Name

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