Owner's Address____________________________________________  City________________________________________________________
State_____  Zip_________  Phone #___________________________

Has dog had any prior training?  Yes____  No____    If yes, what  type?__________________________________________________________________________________________________

Type of training requested:  Protection_____    Tracking_____    Obedience______    Evaluation Only_____

Waiver Of Liability

I________________________________________________________________ understand and do hereby acknowledge that my attendance or the attendance of any family member to any training course or evaluation with VON FALCONER K-9 is not without risk, because of some areas and dogs to which I may be exposed, may cause injury to myself or my dog even when the greatest amount of care is taken.

I hereby waive and release VON FALCONER K-9 and any instructors or employees of VON FALCONER K-9 from any and all liability of any nature for injury or damage which I, my dog, or any family member may suffer, including specifically, but not without limitation, any damage resulting from actions of any person or dog, and I expressly assume the risk of such injury or damage while attending any training session or other function of VON FALCONER K-9 or while at any training location or the surrounding area thereto.

I________________________________________________________________ have read and understand and agree to the above application and waiver.

Signature__________________________________________________________________  Date_________________