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 : obediencecoordinator@4rk9s.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.

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 PriceNon-Member or
Inactive Member Price
6 or 7 Week Class $63.75 $85.00
4 Week Class $42.00 $56.00
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 :
 Sandy Miller
 4RK9s Obedience Coordinator
 1457 Hunters Field Lane
 Marion, IA 52302

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 : obediencecoordinator@4rk9s.com.
Sending Vet Records via USPS -
After Submitting this form send Vet Records to :
 Sandy Miller
 4RK9s Obedience Coordinator
 1457 Hunters Field Lane
 Marion, IA 52302

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

Additionally, during this time of concern for COVID-19 we also need you to agree to our Assumption of risk.

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



Additional COVID Agreement

ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19

The novel Coronavirus (COVID-19) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies have recommended social distancing and have, in many locations, prohibited or limited the congregation of groups of people. 4RK9's, Inc. (hereafter referred to as 4RK9s) has put in place preventative measures to reduce the spread of COVID-19; however, 4RK9s cannot guarantee that you will not become infected with COVID-19. Further, attending and/or participating in any event at the 4RK9s building or at a separate location where 4RK9s is sponsoring the event could increase your risk of contracting COVID-19.

By signing this document, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 as a result of attending and/or participating in any event at 4RK9s and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at a 4RK9s event may result from the actions or inactions of myself or others. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for my decision to attend and/or participate in a 4RK9s event, and any personal injury, disability, illness, death, damage, loss, claim, liability, or expense of any kind, that I may experience or incur in connection with my participation in a 4RK9s event.

I hereby release, covenant not to sue, discharge, and hold harmless 4RK9s, its directors, officers, employees, agents, representatives, volunteers, members, successors, and assigns, and participants from any and all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to my attendance and/or participation in any event hosted by 4RK9s. I understand and agree that this Assumption of Risk and Waiver of Liability Relating to Coronavirus/COVID19 covers any claims based on the action or inactions of myself, 4RK9s, its directors, officers, employees, agents, representatives, volunteers, members, successors, and assigns, local trial hosts, judges, and participants, regardless of whether a COVID-19 infection occurs before, during, or after participation in any 4RK9s event.