Class Registration Mid/Lower Cape – Companion Animal Program

Please complete the form below and click the “Registration” buttons at the end to go to the next page to pay with PayPal for your seven-week course. The class fee must accompany the application and is non-refundable. Teams that do not pass the test after week seven are invited to repeat all or part of a subsequent seven-week class at no additional cost one additional time. All repeat classes are offered ONLY at our Upper Cape location where we have mentors and evaluators ready to assist in your training.

Name of Owner/Handler:

Phone Number:

Address

Address Line 2

City

State

Zip Code

Name of your dog

Your dog's date of birth

Breed

Date of Rabies Vaccine

Due Date for Rabies Vaccine

Please upload your dog’s current Rabies Certificate here. Veterinary invoices are not acceptable.

Is your dog spayed or neutered?

YesNo

Why do you want to become a therapy team?

How did you find out about CAP and/or the CAP training classes?

Have you attended obedience classes or had private training classes?

YesNo

If Yes, please list obedience or training classes you have attended

Does your dog have an American Kennel Club Canine Good Citizen Certificate or equivalent?

YesNo

If Yes, please list

Has your dog ever bitten a person or other dog?

YesNo

Is there any type of situation that bothers your dog, e.g., men with hats, people with umbrellas?

Does your dog have any experience with children?

YesNo

What is your dog's experience with children?

Do you or your dog have any physical limitations?

By filling out my name below, I am agreeing to the following Agreement and Release Statement. AGREEMENT AND RELEASE In consideration for participating in the Companion Animal Program’s (CAP) Training School, Visitation Program, or involvement in any other CAP activities, I agree as follows: 1) I certify that all information that I have provided and will provide to CAP is true and accurate and can be relied upon by CAP. 2) I represent that my animal has and will have up-to-date Rabies inoculations and those immunizations recommended by my veterinarian. 3) I am aware of the inherent dangers of handling dogs and other animals in settings with people and with other dogs and animals, and I recognize the importance of following safety rules in all situations. 4) I agree that while I am participating in CAP activities, I am solely responsible for the behavior, control and well being of my animal at all times. Therefore, I assume all risks related to CAP activities and release CAP, its officers, directors, members, agents or employees if an injury or damage occurs to me or my animal, whether foreseen or unforeseen, related to the activities, and furthermore save and hold harmless CAP, its officers, directors, members, agents or employees from any claim by me or my family or any other party arising out of my participation in the activities. 5) I assume responsibility for my physical fitness in regard to my ability to perform the functions required for CAP activities. 6) I represent that I have read and understand the contents of this Agreement and Release. Name:

Date