Day Adventures Registration Form Dog's Name* How Did You Hear About Us? Has Your Dog Attended Daycare/Training Before? If so where/when? Breed/Mix* Approximate weight of dogMale/Female*MaleFemaleIs your Dog Spayed or NeuturedSpayedNeuturedIntactDate of Birth* MM slash DD slash YYYY Owner's Name* First Last Owner's Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Owner's Phone Number*Owner's Email Address* Enter Email Confirm Email Emergency Contact Name* First Last Emergency Contact Phone Number*Veterinarian Clinic Name* Veterinarian Name* First Last Vet Clinic Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Vet Clinic Phone Number*Expiry Date of Rabies Vaccination* MM slash DD slash YYYY Proof of vaccination required - please attachFile*Max. file size: 128 MB.Expiry Date of Bordetella Vaccination* MM slash DD slash YYYY **Please ensure if your dog is not vaccinated that the vaccination is given a MINIMUM OF 14 DAYS PRIOR to your dog's arrival for training. Proof of Vaccination Required - please attachFile*Max. file size: 128 MB.Do You Vaccinate Your Dog? Yes - Proof of Vaccination Record Required No - Titers Test - Proof of Titer Test Required File*Max. file size: 128 MB.Emergency Procedure* I agree to the Emergency ProcedureUnforseen circumstances can arise in any training program. If an emergency arises with my dog, I undertstand that Prairieburn K9 Academy will contact the emergency contact and myself to notify of the incident. Any veterinarian expenses will be the responsibility myself, the owner. Prairieburn K9 Academy may pay the veterinary bill at the immediate time in the clinic on my behalf, however, reimbursement will be required from myself to Prairieburn K9 Academy. What training program did your dog attend with us?*Has your dog ever bitten a dog or person?*Yes a dog, no punctureYes a dog, punctureNo, my dog has not bit a dogYes a person, no punctureYes a person, punctureNo, my dog has not bit a personHas your dog ever growled or snapped when taking food or toys away?*YesNoHeath & nutrition impact behaviour. What brand of food are you currently feeding your dog?* Has your dog been diagnosed with any communicable disease, bacteria or parasite in the last 30 days? If yes, please explain.*Does your dog have a problem with fleas? If yes, what parasite control do you use?*Bathing* I agree to the Bathing PolicyIn the event that my dog makes a mess in their kennel, I understand that Prairieburn K9 Academy and their team members will spot clean or give a full bath depending on what is required. Prairieburn K9 Academy exclusively uses high quality heavily diluted shampoo to limit any reactions. I understand Prairieburn K9 Academy is not responsible in the unlikely event that my dog has a reaction to the bathing. Does your dog have any mobility issues we should be aware of?*Prairieburn K9 Academy Release* I agree to the Prairieburn K9 Academy ReleaseI release all instructors, assistants, participants, spectators, and all land owners from any damages that may arise, directly or indirectly, as a result of me or my dog participating in activities offered by owners or employees of Prairieburn K9 Academy. I fully recognize that dog training, dog socializing & sporting activities of this nature can be HAZARDOUS. I understand and I am aware that all dog training & related sporting activities involve a risk of injury to any and all parts of the users body, or my dogs body. Despite the risks of injury, I AGREE TO EXPRESSLY ASSUME ALL RISKS of injury or death to me, or my dog while participating in any of the training and or socializing related activities. I understand and agree that this training may not be able to cure my dog’s aggression, or other problems, and I further understand and assume all risks associated with owning and harboring a dog that may be aggressive. As a condition of my dog’s participation in training offered by owners or employees of Prairieburn K9 Academy, harmless from any and all liability or claims I may have or that any other person or entity may have because of any death, bodily injury, personal injury or because of any loss to property that may arise out of or in any way be connected with my dog’s training. I agree that owners or employees of Prairieburn K9 Academy DO NOT guarantee that my dog will do or stop any specific behaviour after training and DO NOT offer a money back guarantee. I understand that Prairieburn K9 Academy agrees to offer follow up support and training whether by telephone, email, social media or in person as per the program I have purchased. I agree that follow up training appointments, if needed, will be conducted at a location specified by the owner and/or employees of Prairieburn K9 Academy. I agree that in the event of a medical emergency or if asked for medical procedures, Prairieburn K9 Academy may have my dog treated by a veterinarian of their choice, and I will be responsible for the cost of any medical treatment. By my signature below, I give my consent to participate in said activities, and I realize that by signing & submitting this form as a legal release, I am forever releasing from liability and agree not to sue any owners or employees of Prairieburn K9 Academy for injuries or damages to me or my dog from any and all manner of actions, causes of such actions, claims and demands whatsoever, in law or in equity, which may arise now or in the future because of, or pertaining to, my participation, or my dog(s) participation in any activities throughout any program provided Prairieburn K9 Academy. I understand this is legally binding on me and my heirs and I sign it of my own free will. Photography Waiver* I agree to the Photography WaiverI am aware that pictures and videos of me and my dog may be taken by Prairieburn K9 Academy and/or a newspaper agency and that these pictures may be posted to a website, social media or published in the newspaper. The pictures will be used for the purpose of illustrating the activities at Prairieburn K9 Academy and may also be used in our advertising campaigns. Pictures posted to the website are considered the property of Prairieburn K9 Academy and may not be sold or reused without the express written consent of the owners of Prairieburn K9 Academy. If there are special concerns or requirements regarding photography of yourself or your dog, you agree to contact Debbi McArthur, Jessie Lavallee, and/or Anthony Boldt or Prairieburn K9 Academy in advance of any training. I have read the foregoing disclaimer and agree to be bound by it. 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