FERNANDO DOSTA JUAREZ

SEMINAR/ PRIVATE LESSONS  FORM and AGREEMENT


It is understood that every dog at this event will at all times be in the care and control of the dog's handler. It is further understood that I, __________________________________, agree to be fully responsible for the actions of my dog(s) while at this event. I agree to hold Midwest Ringsport Club, as well as their members and officers and directors and all property owners HARMLESS for any loss or injury which may have allegedly been caused directly or indirectly to any person or thing by any act of my dog(s) while on the event premises. I hereby assume all responsibility and liability for such claims. I further relinquish all claims and agree to hold this club, their members, officers, and directors and all property owners HARMLESS for loss and injury which may have allegedly been caused directly or indirectly to myself or my dogs(s) during participation in this event. I agree to hold harmless Midwest Ringsport Club, its members or agents for any act committed by this dog or any other dog in my possession.


Print Name: _______________________________________________________

Signature of Owner/Handler: _____________________________Date______

Address: ______________________________________________________________

Phone: ______________________ Email: _________________________

Club Affiliation (if any):_____________________________________________


Dog Name ____________________________________________________

Seminar/privates fee is $75 per session

checks payable to Ron Geller