MEMBERSHIP Application

 

 

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Membership Application  Please cut and paste to word document, fill out the form, sign the waiver, and send by snail mail to:

Martha McGrath

26 Wellington Drive

Bluffton, SC  29910

 

 

Proof of most recent vaccination must be provided with application.  Bordetella requested.

 

Fee for Initial Membership:   $35.00    ($15.00 for each additional dog,   Note: Annual dues may be a separate fee.)

Please sign waiver at bottom of page.

 

Name:                                                     ________________________________________________

 

Address:           Street                 ________________________________________

 

                                City, St, Zip           ________________________________________________

 

Telephone              Home                      ________________________________________________

 

                                Mobile                    ________________________________________________

 

Email                                                      ________________________________________________

 

 

 

Dog Information:  Please list each dog to be involved in Rally practice separately.

 

1.      Dog’s Name   ________________________________________________

 

                Breed/Mix             ________________________________________________

 

                Age                         ____________________     Sex          __________________

 

                Spayed/Neutered                   Yes   ___                                                No   ___ 

 

                AKC Registered  Yes  ___ No  ___    APDT Registered  Yes ___  No   ___

 

                Titles Earned         ________________________________________________

 

             Obedience training               __________________________________________

2       Dog’s Name  ________________________________________________

 

Breed/Mix             ________________________________________________

 

             Age                         ____________________     Sex          __________________

 

                Spayed/Neutered                   Yes   ___                                                No   ___ 

 

                AKC Registered  Yes  ___ No  ___    APDT Registered  Yes ___  No   ___

 

                Titles Earned         ________________________________________________

 

                Obedience training               __________________________________________

 

 

 

 

 

WAIVER, ASSUMPTION OF RISK AND

AGREEMENT TO HOLD HARMLESS

I understand that attendance at a dog obedience session is not without risk to myself, members of my family or guests who may attend, or my dog, because some of the dogs to which I will be exposed may be difficult to control and may be the cause of injury even when handled with the greatest amount of care.

I hereby waive and release the Club, its employees, officers, members and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any practice, training session or other function of the Club, or while on the training grounds or the surrounding area thereto.

In consideration of and as inducement to the acceptance of my application for membership by this Club, I hereby agree to indemnify and hold harmless this Club, its employees, officers, members and agents from any and all claims, or claims by any member of my family or any other person accompanying me to any practice, training session, or function of the Club, or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

 

___________________________________             _______________

(Signature)                                                                                 (Date)

Rally Club of the Low Country

E-mail: lee@dogrally.org