Lake County Kennel Club of Northern California

Class Registration Form

Please Print Clearly

Owner:_______________________________________ Telephone: ________
Please provide a phone number where you can be reached between 5:00 PM and 7:00 PM

Mailing Address: _______________________________________________

City/State: ____________________________________  Zip Code: _________

E Mail:______________________________________________

Dog’s Name:_____________________________________  Breed: _________

Sex (Male or Female):                        Is your dog spayed or neutered?:

Class you are registering for: (please circle one): Puppy Kindergarten

Foundation in Basic Obedience for the Family Canine            

Agility           Rally            Other:_______________________________________

Lake County Kennel Club of Northern California Waiver

I understand and agree to the following: That attendance of a Lake County Kennel Club of California dog event, including but not limited to, shows, puppy kindergarten classes, obedience classes, agility classes, conformation classes, rally classes, use of training equipment, is not without risk to myself, members of my family or quests who may attend, or my dog(s), because some of the dog(s)  to which I/we will be exposed to may be difficult to control and may be the cause of injury even when handled with the greatest amount of care.

I agree to indemnify and hold harmless the Lake County Kennel Club of Northern California, its members, Board of Directors, officers, agents, employees, instructors and staff members from any and all claims, demands, actions, causes of action or liability of any kind whatsoever, for death, bodily injury or property damage caused in part or in whole by our acts, omissions, and/or negligence, the acts, omissions and/or negligence by us, our agents, servants, employees, or assigns.

The right of indemnifications granted above, will exist irrespective of whether the acts, omissions and/or negligence of the Lake County Kennel Club of Northern California or the acts, omissions and/or negligence of any third person or party, also contributed to the loss and will exist as set forth above I all circumstances except where loss was caused solely, as a result of the negligence of the Lake County Kennel Club of Northern California.

I (we) agree to abide by all of the rules and regulations of the Lake County Kennel Club of Northern California.

_________________________________________________________ ____________________________

Signature of Owner or Agent                                                                Date

Please make checks payable to LCKCNC.