Atlanta Dog Agility

Please complete this registration form to be eligible to attend a class or the dogpark.

Your Name:

Address:

City:

State:

Zip:

Home Phone:

Cell:

Email Address:

Dog's Name:

Dog Breed

Age

Weight

Sex

Altered?

Date of last rabies vaccine

Date of last DHLP vaccine

Date of last Bordetella vaccine

How long have you owned this dog?

Does your dog get along well with

Big Dogs	Small dogs	Puppies	All dogs
Does not get along with dogs

I got my dog from

Shelter Humane Society Breeder Other

What training has your dog had

What else would you like to share about your dog?

Which classes are you interested in?

Agility Obedience Puppy Obedience Intro Agility

Flyball Schutzhund Open dog play time

Do you prefer:

Day Classes Evening Classes Weekend Classes

How did you hear about us?

DISCLAIMER: I understand and agree that if I am enrolled in a class, or classes, at Rottstars agility fun and training center , that I will not hold Rottstars, my instructors, other students, their dogs, or other dogs in attendance, or children present liable and/or responsible for any harm or damage that may occur to myself, my dog(s) or my property.

By entering your initials in the box below you Agree with and accept the conditions of the above disclaimer

I agree