Class Registration Information Form

Please print out, complete and send, with inoculation records, to the address listed below.

Registration for BASIC OBEDIENCE must be received ONE WEEK before the start of class.

Class Name:	Start Date:	Time:
How did you find Barking Hills?
Payment:    If you attend all the classes and do the homework and are not satisfied, you may get a refund. Otherwise, Barking Hills has a no refund policy.           I have paid online, using PayPal                                         My check or money order is enclosed
Name:	Dog's Name:
Address:	Dog's Breed(s):
City/State/Zip:	Dog's Date of Birth:	Sex:
Phone (day):	Spayed/Neutered?      Yes    No    Date:
Phone (eve):	Where did you get your dog? How old was he/she?
e-mail address:
Who will handle the dog in class? Name:  Adult          Teen            Child
	Why did you choose this breed?
Can the handler physically restrain the dog if the dog lunges towards another dog?

Is this the first dog you've owned as an adult?    Yes           No
If not, what other breeds have you owned?
Have you taken an obedience class with this dog?    Yes          No                                                                      Another dog?      Yes           No
If yes: Where did you train?
What classes did you take?
Have you ever put an obedience title on a dog      Yes        No      Title(s) earned:
# Adults in your household:				# Children in your household:
List the names of all members of the household and include the ages of all children:
List any other pets in your home: (Please tell us what species and/or breeds)
What do you feed your dog? (brand and type of food, canned/dry)
# Times/day      Amount each feeding:
Is your dog crate trained?               Yes                 No Where is the crate located?
Where does your dog sleep?
How many hours is your dog alone each day?
Where is your dog when you are not at home?
Is your yard fenced?                    Yes                      No
Why are you bringing your dog to class?  What would you most like to accomplish as a result of this class?
Check all that apply to your dog:
	Jumps on people		Pulls on lead		Barks Excessively		Comes when called
	Plays nicely with other dogs		Nips Adults		Nips Children		Barks/lunges at strangers
	Chew/destroys things		Loves new people		Growls when touched/moved		Barks/lunges at other dogs
	Shy/afraid of people		Digs		Nervous in new places		Housetrained
	Bolts out front door		Escapes yard		Steals from table/counters		Soils crate
	Calm/quiet		Guards food/treats		Chases cars		Cries when left alone
	Begs for food		Snarls at you		Takes treats gently		Bumps into you/gets underfoot
	Behaves for grooming		Can be held/handled by your veterinarian/groomer				Bares his teeth at people
How much (in hours) exercise does your dog get each day?  What does it include?
How many times has your dog bitten another dog?  Please tell us about the incident including was this a known or strange dog, what was happening immediately prior to the incident, whether a veterinarian was required, etc.  Use an additional sheet of paper if necessary.
How many times has your dog bitten a human being? Please tell us who (a family member, stranger etc.), the age of the person bitten, where the incident occurred, was medical attention required and what, specifically was happening prior to the bite.  Use an additional sheet of paper if necessary.
What does your dog not like you to do?  (Take toys away, take his food dish, brush her, etc.)
What does your dog do about it? (snarls, growls, walks away, barks, etc.)
Does your dog have any chronic medical problems? Please list anything that is chronic and/or frequently recurring (arthritis, hip dysplasia, patellar luxation, OCD, ear infections, injuries etc.) so that we can modify training techniques as needed to accomadate your dog.
Does the handler have any physical limitations (temporary or permanent) we should know about in order to help train your dog? (Limited or diminished mobility, dexterity or strength; vision or hearing loss; asthma; emphysema; recent injury; back problems; pregnancy; etc.)
Does the handler or the dog have an allergy to peanut butter?   Yes         No
Please tell us anything else about your dog, his behavior or background so that we may better help you: (He/she growls when you take away food, nips at the children, bites shoelaces, won't come when called, jumps on my company, pulls me down the street, soils in the house, runs around - is "hyperactive", chases cars, won't hold still for grooming, etc. - use an additional sheet of paper if necessary)

Agreement, Waiver and Assumption of risk:

I understand that my attendance of a dog obedience training class is not without risk to myself, members of my family and/or guests who may accompany me. I agree to hold Barking Hills Country Club, its owners, employees and the owner of the premises and any employees of the aforementioned parties harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of any dog while on the grounds or in the vehicles of or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; I (we) understand that some of the dogs to which I (we) will be exposed may be difficult to restrain or control and may be the cause of injury to myself (ourselves) even when handled with the utmost care. I (we) further agree to hold the aforementioned parties harmless from any claim for loss of this pet by disappearance, theft, death or otherwise, and from any claim for damage or injury to the pet whether such loss, disappearance, theft, damage or injury, be caused or alleged to be caused by the negligence of Barking Hills Country Club or any of the parties aforementioned, or by the negligence of any other person, or any other cause or causes. I (we) hereby assume the sole responsibility for and agree to indemnify and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or in consequence of my (our) participation in Barking Hills Country Club events, training sessions, classes or any other function, howsoever such injuries, death or damage to property may be caused, and whether or not the same may have been caused or may be alleged to have been caused by negligence of the aforementioned parties or any of their employees or agents, or any other persons.

  I have read and agree to follow the Rules and Regulations

Signed: __________________________________________ Date: ________________

Please print out and send, with a copy of your dog's inoculation records, to:

• Mail:
  Barking Hills Country Club
  1271 Route 22 East - Suite 23
  Lebanon, NJ 08833
  Fax:
  908-236-8883