Houston SPCA: Survey - Training Class Registration

Please provide us with the following registration information


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province:	State / Province: Required
*	ZIP / Postal Code: Required
*	Phone Number: Required
	Yes, I would like to receive e-mail from Houston SPCA

Question - Not Required - Other Phone Number

*

Question - Required - Name of Class
Please make between 1 and 6 selections from the choices below.

	Good Start
	Basic Training Level 1
	Cainine Good Citizen Prep Class
	Tricks & Treats: Dog Training for Kids
	Puppy Socialization
	Kitten Kindergarten

Question - Not Required - If registering for Basic Training Level I, please indicate desired class start date.

Month

Day

Year

*

Question - Required - Name of Pet

*

Question - Required - Species
Please make 1 selections from the choices below.

	Dog/puppy
	Cat/kitten
	Other

Question - Not Required - If "other" species, please specify:

*

Question - Required - Breed

*

Question - Required - Pet's Date of Birth

Month

Day

Year

*

Question - Required - Sex
Please make 1 selections from the choices below.

	Female
	Male

*

Question - Required - Spayed/Neutered?

Question - Not Required - If yes, when?

Month

Day

Year

*

Question - Required - Was your pet adopted from the Houston SPCA?

Question - Not Required - If yes, when?

Month

Day

Year

Question - Not Required - Name of Veterinarian

Question - Not Required - Veterinarian Phone Number

*

Question - Required - Describe a day in the life of your pet, including a list of your pet's immediate family.

*

Question - Required - Do you have any behavioral concerns about your pet? If yes, please describe.

*

Question - Required - Have you owned this type of pet before? If yes, please give a brief history.

*

Question - Required - Have you trained this type of pet before? If yes, please describe methods used.

*

Question - Required - Do you or your pet have any special needs or disabilities we should know about?

*

Question - Required - Why are you taking this course?

(Maximum response 255 chars, approx. 5 rows of text)

*

Question - Required - What do you hope to accomplish by the end of the course?

(Maximum response 255 chars, approx. 5 rows of text)

*

Question - Required - How did you hear about us? I adopted my pet from the Houston SPCA
Friend
Radio
TV
Flyer
Other

Question - Not Required - If other, please specify.

*

Question - Required - I will be paying for the training class via the following method: Bring cash or check with me on the first night of class (All checks must have date of birth, driver's license number, and expiration date to be processed)
Mailing Payment with copy of registration confirmation (All checks must have date of birth, driver's license number, and expiration date to be processed)

LIABILITY WAIVER AND RELEASE

Please read this waiver and be aware that by agreeing to this liability waiver, you are giving up important legal rights. If you wish, you may review this liability waiver with a legal counsel or advisor.

I understand that my participation in any of the Houston SPCA’s training classes, private lessons or consultations that the class (and/or lesson or consultation) includes an element of risk for me, attending family members/guests and my pet, which includes, without limitation, risks of illness, falls, bites and injury through contact with other participants, their pets, or interior/exterior surroundings. I understand that participation by me, attending family members/guests, and my pet is voluntary and that each person hereby expressly agrees to hold the Houston SPCA and its employees and agents harmless from any liability whatsoever resulting from and injuries or damages sustained as a result of participation in the class, even though such liability may arise out of negligence or carelessness on the part of the persons named in this Waiver and Release. I, and attending family members/guests, individual, and on behalf of their respective heirs, assigns or successors, hereby expressly waives, releases and discharges the Houston SPCA and its employees and agents from any claims, demands, injuries, damages or causes of action that are in any way related to participation in the class, even though such liability may arise out of negligence or carelessness on the part of the persons named in this Waiver and Release. The Houston SPCA makes no representations, guarantees, implied or expressed promises that the training received during pet training classes from the Houston SPCA will cure a pet of any dangerous propensities. It is fully understood that regardless of the training received by the animal, a pet always possesses the propensity to bite. I hereby agree to indemnify and hold harmless the Houston SPCA, its employees, owners, and agents from any and all claims, or claims by any member of my family or any other person while on the grounds, the surrounding area thereto, or on my own property or in a public area as a result of any action by any pet, including my own.

I affirm and have proof that my pet is current on all vaccinations appropriate for my pet. I agree to abide by all rules presented during the class.

I also understand that the Houston SPCA may use for publicity or promotional purposes, my name and pictures of me or my pet without liability or obligation to me.

*

Question - Required - I HAVE READ AND AGREE TO THE ABOVE TERMS AND CONDITIONS:

Question - Not Required - As parent or legal gurdian of attending child age 10 or older I have read and agree to the above terms and conditions: