| Iron Range Dog Training Club P.O. Box 14 Virginia, MN 55792 Class:___________________________ Day of Week:_________________________ Please wright in the desired class above and complete the form below. Class fees and times are listed on the Fall Training Session Class Schedule. Dogs adopted from the Humane Society or Contented Critters receive a $10.00 deduction on training in a puppy or beginner class. Owners must show adoption receipt to registrar on the first night of class. Children under 16 who are enrolled in a 4-H dog project receive free training for their first class upon proof of enrollment. If you did not bring your rabies certificate tonight you must bring it on your first night of class. PLEASE COMPLETE ALL INFORMATION: Name: _______________________________________________________Age of Handler if Under 18: ________ Address: ____________________________________________________________________________________ City: ________________________Phone:________________ Email: ____________________________________ Dog’s Name: ___________________________________Breed: ________________________________________ Male or Female (Circle One) Spayed or Neutered (Circle one if applicable) Age of Dog: _________________ Name of Vet Clinic: ______________________________________ Date of Rabies Shot: ______________ Tag#: _____________ Expiration Date: _________________ If adopted from shelter, date adopted: 4-H member information: Circle One: MEMBER Paid by cash____ or check #________ Amount Paid $_________ NONMEMBER How did you hear about IRDTC?_____________________________________ Are you interested in learning about membership in IRDTC? _____________ On behalf of myself, my heirs, executors, administrators and assignees; I hereby waive and release any and all rights and claims for damages which I may have against the Iron Range Dog Training Club, its Board of Directors, training directors, and training staff, as well as any others connected with this class or event, their heirs, executers, administrators, successors and assignees for any and all injuries which I and /or any member of my family and /or friends, or my dog may suffer or cause while taking part in this class or event or as a result thereof. Signature: _____________________________________________________ Date: ___________________ All information was verified by (Registrar’s name): |