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.

Obedience Class Registration

Class Coordinator : lefuglaar@yahoo.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?

Is your dog a rescue?   How long have you had your dog?  

What do you hope to accomplish through this class?

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

Please list any food allergies your dog may have.

How did you find out about this class?

Please check here if it is OK for us to take photos of your dog.

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.

FOR PUPPIES ONLY: If you have a puppy that has begun his/her series of vaccinations, but has not yet received a RABIES vaccination, include the information for the "distemper combo" vaccinations received to date and bring a copy of the remaining vaccination certificates when you receive them from your Veterinarian.

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 Price Non-Member or
Inactive Member Price
6 Hour Class  $90.00 $120.00
4 Hour Class $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:
 Lisa Fuglaar
 4RK9s Obedience Coordinator
6402 River Parkway NE
Cedar Rapids, IA 52411

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 : lefuglaar@yahoo.com.
Sending Vet Records via USPS -
After Submitting this form send Vet Records to:
 Lisa Fuglaar
 4RK9s Obedience Coordinator
6402 River Parkway NE
Cedar Rapids, IA 52411

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