Southern Michigan Obedience Training Club
LOCAL PHONE: 248-546-2727
Application for Adult Education—Dog Training

I hereby make application to enroll as a student using the methods of training dogs in obedience
exercises as these exercises are outlined by the American Kennel Club; and to enroll the dog
described herein for training.

I agree, as a condition to the acceptance of this application, to abide by the rules and regulations of
the Southern Michigan Obedience Training Club; and further agree NOT to substitute another person
in my place EXCEPT if the instructor expressly consents to such substitution – and to
withdraw my dog and/or the substitute trainee in the event that the instructor
determines that they are not compatible in their training efforts.

Name of Applicant/Trainee: _______________________________________________________

Street Address: ______________________________ City: ___________________ ZIP: _______

Phone Number: _____________________ E-Mail Address: ______________________________

Age of Trainee if under 18: ____________ SEE WAIVER BELOW

Breed of Dog: _________________________________ AKC Registered: Yes ? No ?

Dog’s Name: _______________________________ Age: _______ Sex: M ? F ?
Have you or your dog been previously trained in obedience work? Yes ? No ?

Where? ________________________

How did you learn about this class? __________________________

In consideration of the acceptance of this application I agree to hold Southern Michigan Obedience
Training Club, its members, directors, agents, instructors and assistant instructors, HARMLESS
from any loss or injury, regardless of the cause, which may occur to me, my dog, my property or the
person and property of any family member or other person accompanying me, while attending any
class or function of Southern Michigan Obedience Training Club, or while on the training premises
and surrounding area.

Date: ________________ Signed: _________________________________________
(If under 18, parent or guardian must sign below)

Enrollment Fee: $______

I agree to act as the applicant, and to be present at all scheduled training classes (if the trainee is under age 18) and
agree to withdraw the trainee upon the instructor’s request, if the instructor determines that the trainee and/or dog are not
compatible to training.

Signed: _________________________________________
Parent or Guardian