Membership Application Please cut and paste to word document, fill out the form, sign the waiver, and email as an attachment to Lee@dogrally.org or send by post to:

Lee Brewer

53 Pine View Dr

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)

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Rally Club of the Low Country

E-mail: lee@dogrally.org