"*" indicates required fields PUPPY SOCIAL! (Held 1 or 2 Saturdays/month) CLASS FEE: $25 NOTE: If you are seeking financial assistance for this class please email [email protected] before proceeding to discuss your class options.Puppy Social Class Sign Up Options*(Each class = 45 minutes / $25) Sat 9/30 (11-11:45am)- Puppy Social (6 slots available) Sat 10/28 (11-11:45am)- Puppy Social (5 slots available) Total Owner Name* First Last Owner Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Owner Phone*Owner Email* Will you be bringing your own dog or a foster dog to this class?* My dog Foster dog If you are bringing a foster, which organization are you fostering your dog through? Dog Name* First Dog Breed or Mix* Dog Birthdate (Dogs must be under 6 months old to attend class)* Dog Gender* Male Female Is your dog spayed or neutered?* Yes No Is your puppy up to date on all required vaccinations for their age? (Distemper/DHPP, Bordetella, Rabies)?*All puppies must have at least 1 round of puppy shots. Yes No A copy of your dog's vaccine history is required to begin class. Upload medical records here in PDF, JPG or JPEG format, 4MB max file size.You may instead email these records to [email protected]. File formats accepted to upload: PDF, JPG, JPEG, with max 4MB file size.Accepted file types: pdf, jpg, jpeg, Max. file size: 4 MB.Veterinarian Name* Veterinarian Phone*Family member who will attend class with you.(No more than 2 guardians per dog allowed). Have you attended any other training classes with your dog previously? If yes, please explain.What do you hope to accomplish during your time in training class?Coupon Donation AmountPlease consider gifting a class to an underserved family through our Community Canine Training Program Scholarship Fund. Every $100 donated fully sponsors a person and their dog! Simply enter the amount you would like to donate and that will be added to your cart at checkout. Total Accident and Liability Waiver*I understand the inherent risks of owning a dog, including but not limited to the risk of dog bites to myself or others, and consequently I am and will remain responsible for the actions of my dog at all times. I hereby agree to abide by the rules and policies of Agape training classes as set forth in this contract. I understand that attendance of dog training classes and programs is not without risk to myself, members of my family, guests who may attend, or to my dog. In consideration of, and as inducement to the acceptance of my application for training membership in this training class or program, I hereby agree to indemnify and hold harmless Agape Animal Rescue and Training Center, its officers, directors, instructors, volunteers, employees and/or representatives of any and all claims, or claims by any member of my family, or accompanying guests of mine of injury, expense, costs or damages to myself, my dog or any handler sponsored by me both in class and out of class. In addition, I agree that I will defend and indemnify Agape for any injury, expense, costs or damages to any dog handlers or dogs, whether sponsored by me or not, or to third parties arising out of my own actions or the actions of my dog. I have read and agree to the terms above Class Cancellation Policy*We require cancellation notification at least 48 hours prior to your class start day and time. If we do not receive this notice, we lose the opportunity to fill your spot and a refund will not be given. I have read and agree to the terms above Media Policy*By accepting these terms, I agree that photos and videos of me, my dog, and any other guests who attend class with me may be used on any and all media outlets for advertising and any other purpose we choose. You release Agape and its legal representatives from all claims and liability relating to photos and videos taken during training classes. I have read and agree to the terms above Please Confirm Share This Facebook Twitter Email