Paid:
Website:                                  Cheque 
                                                 Cash 
www.heatherleacanine.com    Gift Certificate 
                                                 Receipt # : _____________
                                                 Amount: _______________
You must  pre pay to receive discounts.
Mailing Address:       Box 62032
                                    104 Regent Ave E.
                                    Winnipeg MB R2C 5G2
                                    Email to: heatherleatraning@shaw.ca
                                    Phone:  222-3100

        REGISTRATION FORM

YOUR NAME: ___________________             DOG  INFORMATION:

ADDRESS:_______________________            DOG’S NAME: _______________________
CITY: ___________________________            BREED:  _____________________________
POSTAL CODE: __________________            AGE:  _______________________________
HOME PHONE: __________________
WORK PHONE: __________________           

WHERE DID YOU HEAR ABOUT OUR                 Type of Class: _____________________
CLASSES ? _________________________               Date Class will Start: ________________

 

AS A CONDITION TO ACCEPTANCE OF THIS APPLICATION, THE AGREEMENT BELOW MUST BE SIGNED.
AGREEMENT TO INDEMNITY RELEASE HEATHERLEA AND ASSUMPTION OF RISK.

                I understand that attendance at a dog training class is not without risk to myself, to members of my family, or to guests who may attend, or to my dog and I hereby accept such risks.  I understand that 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 agree to advise any person accompanying me as my guest of the risk of attending training classes.

                I hereby release and discharge “HEATHERLEA” (hereinafter called the “Training Organization”), it’s employees and agents from all claims, demands and liability whatsoever which I now have or may hereafter have, (particularly while at any training session or any function of the Training Organization or while on the grounds or the surrounding area) in respect to any injury or damage suffered as a result of any action by any dog (including my own) or any person, and I agree to indemnify and save harmless the Training Organization by any member of my family or any person accompanying me or against the Training Organization by any other person should such claims, demands or liability arise from such action by myself or any person accompanying me or my dog.

I will have 24 hours from Orientation to withdraw my dog, my money will be returned to me upon Heatherlea Canine Education’s receipt of the Training Manual in excellent condition, after such time no money will be refunded.

Signature of owner: _________________________________________  DATE: _______________________________