Support NHS

1.

Your information

*

Name:

First Required	Last Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from Nebraska Humane Society.

*2.

Question - Required - Date of lesson

Month

Day

Year

*3.

Question - Required - What is your dog's name?

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

*4.

Question - Required - What breed is your dog?

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

*5.

Question - Required - What is your pet's rabies tag number?

*6.

Question - Required - What do you want to work on with your trainer?

*7.

Question - Required - WAIVER AND RELEASE: I hereby acknowledge that there are certain risks and potentially hazardous activities associated with the class, training, or instruction in which I or some other person or animal under my care and control, seek to participate. Such risks include, but are not limited to, injury or damage which may occur as a result of actions associated with the actual training or class itself, other participants, or other animals or pets involved. I agree and represent that I am authorized or able to make this consent, waiver, and release on behalf of the participant(s) I am registering, and agree that the terms "I", "me", or "my" shall include such participant(s).

*8.

Question - Required - In consideration of being allowed to participate in the class, training, or other instruction, I, and on behalf of or for my executors, administrators, heirs, next of kin, representatives, successors, and assigns, hereby release and forever discharge The Nebraska Humane Society, its employees, agents, volunteers, Board of Directors, and other individuals or entities associated with The Nebraska Humane Society from any and all liability, including but not limited to, personal injury, property damage (including any injury to my pet or animal), property theft, or any other type of injury or damage associated with or as a result from the class, training, instruction, or participation. I agree to follow the rules established by The Nebraska Humane Society and agree to abide by any decision by The Nebraska Humane Society or its agents as to the ability or capability for me or my pet to participate or complete the class, training, or other instruction.

*9.

Question - Required - I grant permission to The Nebraska Humane Society to use any photograph, motion picture, video, or any other record for any lawful purpose. I have read the above 3 questions language, and, by selecting "YES" below, I accept and agree to such terms.

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