Application for NB Productions

Please circle the class and the location you are interested in.
Puppy Kindergarten for puppies from 8 to 21 weeks, Beginner Level, Introduction to Rally Obedience, Intermediate Level Fee: $85.00 The Civilized Canine (CGC) Fee: $95.00

Greenfield, MA, Turners Falls, MA, Wendell MA, Brattleboro, VT

Make Checks Payable to Pam Murphy
48 J Street
Turners Falls, MA 01376
1-413-863-3732
NO REFUNDS

Trainer’s Name: ____________________________________________________
Street: _________________City: ______________ State: _____ Zip: __________
E-Mail: _________________________________________________________
Breed of Dog: _________________ Age: _____ Name: ______________________

Phone :_____________

Please answer all questions.
Are you experiencing any immediate problems? Yes No What are they?
________________________________________________________________
________________________________________________________________
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Has your dog been socialized with people other than family? Yes No
Has your dog been socialized with other animals? Yes No

Agreement: Please read and sign.
In consideration of the acceptance of this application I (we) agree to hold this organization and it’s agents, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or upon the premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss of this dog by disappearance, theft, death or otherwise, and from any claim of damage or injury to the dog, whether such loss, disappearance, theft damage or injury be caused or alleged to be caused by the negligence of the organization or any of the parties aforementioned, or by the negligence of any other person, or any other cause of causes.
Signature of owner or his/her agent duly authorized to make this application:

_______________________________________

For Office Use Only
Date: _____________ Fee Paid: __________ Cash: ____ Check Number: __________
Medical Information OK? ________
Received By: _________________