THE NORTHERN NEW JERSEY GERMAN SHEPHERD DOG CLUB

TRAINING REGISTRATION FORM

 

Name of Handler ( at least 16 yr. old) / Owner :____________________________________________

Address: ___________________________________________________________

Contact Number : Home _________________ Business _________________Cell____________

Email Address _________________Contact Preference__________________

Name of Dog : ____________________________________Breed _________________

Sex : M/F Age (3 Mon. or older) ___________ Spay/Neuter Y/N Dog / People Friendly (circle)

Please state if there are any problems with this dog that concern you ______________

_____________________________________________________________________

CHOICE OF CLASS : Puppy-_____Beginner _____ Intermediate Novice _____Advanced ______

Are you interested in: Basic Obedience __ Competitive Obedience __ Canine Good Citizen Course __

Please tell us what you expect from the class ____________________________________________

Name of Breeder : ________________________Rescue Organization__________________________

AKC Registration Number : ___________________________

Veterinarian Name : _________________________Phone___________________________________

Proof of Rabies Submitted Y/N

Current on Vaccinations (Parvo,Distemper,Hepatitis,Leptospirosis,Bordetella Y/N

Is this your first dog? Y/N In Your Household : Dogs: ____Cats : ___Children/Age______________ Have you trained before ? _____________

How did you hear about us ? Newspaper Name :_________Internet :Y/N    Referred by_____________

ARE YOU A MEMBER of this Club? Y/N If not, would you be interested in becoming a member of The Northern New Jersey German Shepherd Dog Club - for GSD Only ________

Would you volunteer on a committee? Y/N   What Interests you :

Training the German Shepherd or an All Breed includes participation in "hands on" training, with attendance at orientation/education/discussions. This is an integral aspect of obedience training, and is considered part of the Trainees application.

By signing below, you agree and consent that your dog / handler / owner, may be removed from class at any time in the event that, in the trainer/obedience coordinator sole discretion, your dog / handler/owner creates a safety issue for any other dog / handler / owner, or other animal or individual.

You certify that the above information is correct, and accept full responsibility / liability for your dog.

Print Name : _____________________________________

Signature : __________________________________Date_____________________

 

 

Pre - Registration for Training Classes

 Print, and Mail completed form with copy of Rabies Vaccination, with check :

Puppy Class TBA - Beginner / Novice Obedience or Advanced / Competition
Class 75.00 Members / 150.00 Non Member to:

Michelle Lustberg
505 Tether Lane
Paramus, New Jersey 07652

- or -

Simply print the form and bring with you to the next registration class.  See "Classes and Lectures