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Print and Mail or Fax this Form to:
Tri-Valley Facility:
East Bay SPCA Pet First Aid Registration
4651 Gleason Dr.
Dublin, CA 94568
Phone: 925-479-9670
Fax: 925-479-9680
Email: Training@eastbayspca.org
Oakland Facility:
East Bay SPCA Pet First Aid Registration
8323 Baldwin St.
Oakland, CA 94621
Phone: 510-569-0702
Fax: 510-569-1608
Email: Training@eastbayspca.org
East Bay SPCA Pet First Aid Class Registration Form
Registration Information
| Class Date: |
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Name: |
Day Phone Number: |
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Address: |
City: Zip: |
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Email Address: |
Names of other family members who will
Attend: |
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How did you hear about us? |
Class Information:
Cost: $75 per person
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Time |
Day |
Date |
Location |
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12pm - 4:30pm |
Sunday |
4/6/08 |
Tri Valley |
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12pm - 4:30pm |
Sunday |
5/11/08 |
Oakland |
NOTE: Class size is limited and enrollment is on a first-come, first-serve basis. Your enrollment will be confirmed via email or telephone.
Payment Information:
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Paid by: Check Cash VISA Amex Mastercard Discover |
Expiration Date: |
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Name on Card: |
Amount: |
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Card Number: |
All Fax and email registrations must be paid by Credit Card. Payment must be made at the time of registration.
Agreement
I hereby acknowledge that I have voluntarily applied to participate in Pet First Aid with the East Bay SPCA and Pawsitive Steps Dog Training, LLC. I am aware that there are inherent risks and hazards involved in activities with and around animals and the Tri-Valley and Oakland SPCA facilities, and I am voluntarily participating in these activities with knowledge of these potential dangers. I am not relying on the East Bay SPCA instructor or any associate of the East Bay SPCA to prevent such occurrences. In order to participate in pet first aid classes, demonstrations or other activities, I, being fully informed of such risks and hazards, agree to assume all risks of such occurrences. I hereby waive any and all claims or actions I or my guardians, representatives or assigns may have from any and all personal injury to myself, or harm to property caused directly or indirectly by acts that might occur in training classes or other activities. I also agree to assume sole responsibility for injury or damage caused by myself and further agree to indemnify, defend and hold the instructors, associates and assistants, harmless from any damage, loss, liability or expense, including legal cost and attorney's fees, which result from damage caused by myself. I also agree that this class is voluntary and the information presented is designed to assist, not replace, medical advice for an animal. The East Bay SPCA is not responsible for how the information is applied to animals outside of this training. I agree to adhere to policies accompanying the Pet First Class as presented at the beginning of class or agree to not participate.
Signature: ________________________________________
Date: ___________
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