Class Details

In which class would you like to enroll*?	Select a Class

Start Date:	Select Start Date

*If you are unsure, please advise your dog’s DOB and we will book appropriately

Your Details

Name: Telephone (BH):

Address:

Email:

Your Dog’s Details

Name: Sex: Select	DOB: Select DOB

Breed:	Colour:

Was your dog at adopted from RSPCA?	Select

Annual vaccinations, worming and flea treatments current? Select

Does your dog have any pre-existing medical conditions? or have they been in contact with any suspect/contagious animals? Select

If yes, details:

How did you hear about RSPCA Dog Training School? Select

Do you give permission for your’s and/or your families members image to be used in RSPCA publications and website? Select

Would you like to be added to the RSPCA mailing list? Select

☐Email form along with a copy of your dog’s current C5 vaccination certificate to: pac@rspca-act.org.au

Office Use Only: Payment Processed Vaccination Certificate received and current Confirmation/Information Letter Sent Initials:_________

Payment Options

I would like to pay by: Select

Credit Card Type:	Select Card Type

Name on Card:

Card Number:

Expiry Date:

CCV Number:	(3 digits)

Signature: Enter your name to authorise	Date: Enter date.

Attendance Agreement

Payment is required at time of booking. Payment may be made via credit card (page 1), over the phone or in person at the RSPCA Shelter.

Bookings will not be made without payment.

Cancellations of bookings made with a minimum 7 days’ notice will result in the refund of all monies paid.

Cancellations that are made with less than 7 days’ notice will not be refunded.

For safety reasons, participants must wear the appropriate clothing. Appropriate clothing includes a hat and closed toe shoes. Thongs and sandals are not acceptable footwear. A participant will be refused entry if not dressed appropriately. Participants are advised to wear sunscreen.

Participants can bring along one family member to the orientation (space limitations) and more family members to the training sessions. Each child must be supervised by an adult. Children must be able to participate in the orientation or training sessions without disrupting the class, otherwise you may be requested to leave the session and will not be credited for the missed session.

If a participant puts themselves, others or animals at risk, they will be removed from the program

Participants that do not attend classes for more than 6 months are required to repeat the orientation and introduction classes

Participants that attended our previous “Life Skill’s” Program are required to attend the orientation and introduction classes

DISCLAIMER

I understand while the RSPCA ACT takes all reasonable precautions to ensure the safety of participants, all participants enter at their own risk. I consent to taking part in training sessions. By enrolling in these programs you acknowledge that you understand this disclaimer and release RSPCA ACT and its employees, agents, volunteers and contractors from any liability whatsoever, to the extent permitted by law.

I have read and understand the above Attendance Agreement

Signature: Enter your name for signature	Date: Enter date.