AGILITY ABILITY    


REGISTRATION  & SCHEDULE

REGISTRATION IS NOW CLOSED.
Classes are full for Winter 2019

Please check back in April
for our Summer Camp in June!





  

Please pay through any of our three easy options:

1) Paypal button below
2) Mail payment to Agility Ability: 3351 Cheshire Rd., Delaware OH 43015
3) County Funding by emailing Connie a PAS from your Service Provider

4) Scholarships are available upon request
*Payment must accompany signed Waiver/Registration form below*

upon availability!   today!

 AGILITY ABILITY    
AGILITY ABILITY CLASS REGISTRATION & WAIVER
Class Sessions will be held at A.R.F. facility (Agility and Rally for Fun) located at 1000 Morrison Rd., Suite i, in Gahanna. Because of our limited dates & number of children we can have per class, payment for sessions will be accepted on a first come basis. Payment along with this completed Waiver/Registration form for the classes must be completed and mailed to: Agility Ability c/o Connie Will 3351 Cheshire Rd., Delaware, OH 43015 and will be accepted on a first received basis. Acceptance/Acknowledgement of your registration & payment will be sent via email (or phone call) once received.

WINTER 2019 CLASS SCHEDULE (6 classes): Saturday, JANUARY 19, FEB. 2, FEB. 9, MARCH 2, MARCH 16, MARCH 30 Classes begin at 10 a.m. only. We cannot refund once classes begin. Total Due for all 6 classes is $120.00. Please pay by check to Agility Ability or Paypal below.

CLASS REGISTRATION FORM:
PARENT/GUARDIANS NAME:__________________________________________________________________ Participant’s Name:_________________________________________________________________ Age & D.O.B_____________________ ADDRESS:________________________________________________________________________________________________________________________________________ EMAIL ADDRESS:________________________________________________________________ CELL NUMBER: (may we text you?)_______
_______________________________________________________________________
HOME PHONE NUMBER:_________________________________________________________________ EMERGENCY CONTACT NUMBER:_________________________________________________________________ Participant’s Diagnosis \ (or explanation if necessary): ________________________________________________________________________________________________________________________________________________ Participant’s Likes/Dislikes/Fears:___________________________________________________________________
Does Your Child have any Fears of Dogs or Aggression toward Dogs? (If so please explain)__________________________________________________________________
Does your child have any food allergies?_________________________________________
How did you hear about us?:__________________________________________________

Waiver/Release from Liability for Agililty Ability & Agility and Rally for Fun, LLC
In consideration for being allowed to participate in agility programs, work with agility trainers, staff and volunteers, use agility equipment, work with agility dogs, and enter the premises where activities will be held by Agility Ability and Agility and Rally for Fun, LLC, the undersigned, on his or her behalf, and on behalf of the minor identified below, and those persons or entities set forth in numbered paragraph 3, acknowledges and agrees that: 1) There is a risk of injury from participation in the activities engaged in, and while particular rules, equipment and personal discipline may reduce the risk, the risk still exists and is accepted and assumed by me; and 2) I knowingly and freely assume all such risks, both known and unknown, and however arising, even if arising from an agility dog or from the negligence of other participants, volunteers, staff and employees. I will assume full responsibility for the participants listed below. I agree to assume liability for all medical costs, attorneys’ fees and any and all other expenses and damages resulting from injury to myself, the participants listed below and those persons and entities set forth in numbered paragraph 3 below, and 3) I, for myself and on behalf of my spouse (if any), children, heirs, hereby release and hold harmless Agility Ability and Agility and Rally for Fun, LLC, and its employees, volunteers, and all other participants with respect to any and all expenses, medical bills, causes of action, claims, injury, disability, loss and damage to person or property to the fullest extent permitted by law.

Participant Name _______________________________________
Adult Guardian Signature___________________________________
PRINT Adult Guardian Name_________________________________

AGILITY ABILITY PHOTOGRAPH/PUBLICATION RELEASE FORM
We request permission for your child_________________________________ to have his/her picture taken or to be videotaped by a member of Agility Ability Dog Agility Therapy Team. If permission is granted by signing below, your child’s picture and/or name, may be used in newspaper articles, television stories, brochures, websites and other promotional publication and video productions.
____ Yes, I give my permission
____ No, I do not give my permission Parent or Guardian’s Signature Date
**YOU DO NOT NEED TO SIGN THIS FORM AGAIN IF YOU HAVE DONE SO ALREADY.**

FOR AGILITY ABILITY USE;
Payment type:_____________   Date Pay Received:____________ Amt Paid:________
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