ADDRESS:                                                                            

CITY:                                                         STATE:             ZIP:                          

HOME PHONE: ________________   WORK: ______________  CELL: _______________

E-MAIL ADDRESS: _________________________________________________________

NAME OF DOG:                                                                               DOB:            

BREED:                                                   REGISTRATION #:                                  

TATTOO #:                               SCORE BOOK #:                                               

DATE OF RABIES VACCINE:                    (Please submit copy of Vaccine Certificate)

NAME OF DOG:                                                                               DOB:            

BREED:                                                   REGISTRATION #:                                  

TATTOO #:                               SCORE BOOK #:                                               

DATE OF RABIES VACCINE:                    (Please submit copy of Vaccine Certificate)

LIABILITY WAIVER
I,                                                                                        , promise to comply with all the norms, rules and constitutions established by Vom Artiles Kennel, French Ringers Club, Florida NVBK Club, and Palm Beach Schutzhund Academy, their owner and/or their affiliates, to defend the objective and purposes of the same, and release the above named clubs and/or club affiliates, its Board of Directors, individual members, club affiliates, trainers, participants, spectators, and members whose dog/s are registered in the club, for any type of lawsuits, claims, demands, damages, costs and expenses of any nature, including the payment of lawyer and court fees and expenses from consequences or results of my use and/or participation and/or assistance in activities sponsored by any of the above named clubs, the use of its facilities, rented equipment, instructions, training, demonstrations, competitions, seminars, and any other type of activity related with the objectives for which the above named clubs and/or club affiliates was created.  I am fully aware that dog training can result in injuries and accidents that can cause dog bites and other types of physical injuries.  I fully accept this risk and fully agree not to sue Vom Artiles Kennel, its clubs, owners, members, and visitors.  I understand and have been explained that I must have my own personal health, disability, and life insurance in order to be a member of this organization and have coverage at all times for any injuries or even death that can occur while draining dogs in this dog training organization and facility.  I will consider and accept Vom Artiles Kennel, its clubs, and entire organization held harmless of any lawsuits.

                                                                                                                        
Signature                                                                                 Date