South Mountain
Dog Training Center
4785 South Mountain Drive
Emmaus, PA 18049
Office - 610-966-4447

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Full Name:

Spouse's Name:





Class Preferred:

Puppy Pre-School

Beginner - Monday

Beginner - Saturday


Phone Number:

Cell Number:


Dog's Name:

Dog's Breed:

Dog's Age:

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Has your dog had previous training (enter YES or NO):


Please use the box below to describe training:

Please select appropriate box below describing your dog's personality:

Shy (enter YES or NO):

Nervous (enter YES or NO):

Aggressive (enter YES or NO):

None of Above (enter NONE):


Please box below to describe your dog:
( ie; well mannered, eager to learn, descipline or behavior problems)

Liability Waiver

I understand that attendance in a dog obedience training class is not without risk to me, members of my family, guest who attend or my dog. Some of the dogs I (we) will be exposed may be difficult to control and may be the cause of injury and/or damage even when handled with the greatest amount of care.

Upon acceptance of my application to attend this dog obedience training class, I hereby agree to waive, release, indemnify, compensate and hold harmless, Larry Underkoffler, South Mountain Dog Training Center, any instructors, apprentices, or helpers and/or agents hereinafter referred to as South Mountain Dog Training Center, and the owners of the premises for injury and/or damage which I my family, guest, or my dog may suffer, including, but not limited to, any injury or damage resulting from the action of any dog(s) within or during training class, before and/or after class ends or on the training floor and/or property grounds.

Type full name here for Liability Waiver:

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