Cape Cod Kennel Club
Agility Registration Form

Class Signing Up For:_________________________________________________Start Date: ________________________

Your Name _______________________________________________________________________________________________

Address __________________________________________________________________________________________________

City, State Zip ____________________________________________________________________________________________

Telephone (home) _________________________________________________Cell___________________________________

Email ____________________________________________________________________________________________________

Dog's Name ___________________________________________ Sex (M/F) _____

Breed ______________________________________ Date of Birth _____________

Veterinarian:__________________________________________________________________Spayed/Neutered______________

Goals: Try agility ________ Competition ___________ Other ______________________________________________________

Prior Agility/Obedience Training Classes/Titles:______________________________________________________________________________

____________________________________________________________________________________________

I agree to abide by the rules of Cape Cod Kennel Club while attending or participating in training classes. I do not hold the training facility or instructors for the Cape Cod Kennel Club or any persons connected therewith, or Cape Cod Kennel Club members responsible for any loss or damage incurred by me or my dog, or by others to me or my dog. I understand that, at the discretion of the Trainer, any dog exhibiting uncontrollable disruptive and/or aggressive behavior, or appearing to be in poor health, may be asked to withdraw from the class. I acknowledge that the enclosed fee is non-refundable.

___________________________________________________________________________________________(__________________________________)
Signature of Owner (Date)

SEND this completed form AND
- A copy of your dog's rabies vaccination record, if not already submitted
- A copy of the adoption papers if claiming the one-time $5 rescue discount
- A check made payable to Cape Cod Kennel Club for $505 ($140 for club members), less the one-time $5 rescue discount if applicable

TO: Cape Cod Kennel Club c/o Heather Garre PO BOx 2003, Brewster, MA 02631

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