Class Registration

TO REGISTER FOR A CLASS ONLINE: Three steps are necessary :

  1. You must complete this form and press the Submit button.
  2. You must get your payment to the class coordinator. You can either use PayPal or mail a Check directly to the coordinator.
  3. You must make your vet records available to the coordinator in a form that can be kept. Therefore you must either send a copy via mail. Or you may email a legible copy to the coordinator.

On this Form use of the Submit button means I agree to be bound by the "Agreement" below.

I agree by my signature to hold 4RK9's, its members, directors, officers, the owner of the premises used for training, and any party or employee of the aforementioned parties, harmless from any claim or loss which may be alleged to have been caused directly or indirectly to any person, animal or things by this dog while in or upon the premises or near the entrance thereto.

I personally assume all responsibility and liability for any such claim. I further agree to hold aforementioned parties harmless for any such claim for the loss of this dog due to disappearance, theft, damage or injury or any other causes. I am solely responsible for my children's safety and welfare as well as their supervision during the entire time they are present on the training grounds.

To the best of my knowledge this dog is free of any contagious or potentially contagious diseases.

Agility Class Registration

Class Coordinator : omalleylou@gmail.com

Class Date & Title :  

Handler's Name :     Dog's name :  

Street Address :

City, State, Zip :

Phone Number : Email address :   

Most instructors prefer an e-mail address for communication with students pertaining to the class and for class confirmation. Please indicate if you require telephone.

Breed : Date of Birth : Male Female   Spay/Nuetered?

What do you hope to accomplish through this class?

What previous dog training experience do you and/or your dog have (recent classes taken)?

Have you previously shown in a trial or plan to? If planning to soon, where and when?

How did you find out about this class?

Check here if you wish to receive email information from the club at the conclusion of this class

VACCINATION CERTIFICATES

You MUST provide a copy of your rabies and distemper combo (distemper and parvo) vaccination together with this form regardless of how many previous classes you have attended at 4RK9s. This information is required by regulations of the State of Iowa.

Most recent Rabies Vaccination Date Date Next Due

Most recent Distemper & Parvo virus Vaccination Date Date Next Due


FEE SCHEDULE
if unsure of fee, check Class Description
Class Member PriceNon-Member or
Inactive Member Price
6 Week Class
starting prior to 6/15/22
$63.75 $85.00
4 Week Class
starting prior to 6/15/22
$42.00 $56.00
6 Week Class
starting on or after 6/15/22
$90.00 $120.00
4 Week Class
starting on or after 6/15/22
$60.00 $80.00
Amount to Remit : $

Select Payment Method : PayPal Check

For PayPal Payment -
After Submitting this form you must click the 'OnLine Payment' Button or contact coordinator to arrange payment.
For Check Payment -
After Submitting this form send check to:
 Lou Ann O'Malley
 4RK9s Agility Coordinator
 4006 Richland Dr. NW
 Cedar Rapids, IA 52405

Select Vet Records Method : I will email I will send via USPS

Emailing Vet Records -
After Submitting this form you must email your Vet Records to the Class Coordinator : omalleylou@gmail.com.
Sending Vet Records via USPS -
After Submitting this form send Vet Records to:
 Lou Ann O'Malley
 4RK9s Agility Coordinator
 4006 Richland Dr. NW
 Cedar Rapids, IA 52405

I have read the Agreement at the top of this form and I agree to the conditions called out.