Enrolment form - Group Class (single dog) Owner informationOwner / Handler name(s)* Occupation(s)* Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Phone Instagram Account Name We often use Instagram to keep you updated. If you have an account and would like us to tag you please provide us with your Instagram account.Dog informationDog name SexMaleFemaleAge DesexedYesNoNot yetMicrochippedYesNoBreed Current Vet Clinic Previous training None Self trained Puppy school Obedience club Does your dog have any medical issues? Current veterinary clinic Class informationWhat class would you like to enrol in?Canine CarnivaleCompanion ChampionsWorkshopBoard & TrainWho do we contact in case of emergency?* Contact number* How did you hear about Canine Connect?* AgreementSignature*I understand that I am fully responsible for both my own and dogs behaviour and safety during all classes and activities with Canine Connect. All handlers under the age of 15 are to be accompanied by an adult. I agree there shall be no liability or responsibility in the event my dog dies, is injured, or contracts a disease or illness during any services held with Canine Connect and their affiliates provided reasonable care is provided and I agree to pay all fees and charges incurred with such services. Unless otherwise authorised no refunds will be given and late cancellations or 'no shows' may incur a fee. Any digital photography or film may be used for the purpose of advertising by Canine Connect across all medias. If in the opinion of Canine Connect or affiliates that your dog required medical attention or assessment I agree and authorise the proprietors to obtain necessary services on my behalf and I agree to pay all fees in connection with such services. I agree that there shall not be any liability or responsibility imposed on the proprietors in any manner whatsoever in the event of my dog dying or being injured. I understand extensive procedures are put in place to protect my dog from injury or illness and will not hold Canine Connect responsible in the event injury or illness occurs. I understand that Canine Connect only employs qualified and recognised canine trainers and that whatever training aids the choose to use with my dog during their stay is in the best interest of my dog, myself and any decision on training tools is from a qualified and educated perspective. I also understand the tools used in training may not necessarily be the tools recommended for me to use post stay. I agree to pay any charges that may incur during the period of training within the period provided or extra charges may occur.Untitled