Rummy’s Beach Club offers warm water dog swimming to benefit dogs who are in pain from arthritis, overweight, have had an injury or surgery or for dogs who just for fun! (Spring, Texas 77389)

Dog Swimming Class Application

We can email this form to you - OR - you can copy and paste this form into a word document, then can complete it and mail it in with your check or money order. Please write or type your answers in a different color ink – thank you!

Date:

Name:

Gender and ethnicity:

Are you fluent in the English language? Yes No

Address: Street, City, State, Zip:

Email:

Can I share your email with your classmates? Yes No

Can I add you to Rummy’s email list? Yes No

Contact Phone: Cell Phone, Home Phone, etc.

2 emergency contacts, relationship to you, names and phone numbers.

Employer and how long:

How did you hear about Rummy’s Beach Club, LLC? (Please circle.)

Vet, Friend, Family, Colleague?

Saw Rummy’s Beach Club at an Event or Show. Which one? Where?

My kids met Rummy at their School, Library, Church, etc. Where?

Internet Search. Which one?

Magazine Ad. Which one?

Craig’s List _ Kijiji _ Angie’s List _Newspaper _ TV _ Other:

You will be staying with us for a few days, please list food and other allergies:

Tell me about your dog(s): Name, Age, Breed, Gender, Weight, Color, neutered or spayed, where you got your dog(s)?

Has your dog ever used a Dog Orthopedic Surgeon, Acupuncturist, Chiropractor, Massage Therapist, Physical Therapist, Trainer, Psychic, Other? If yes, explain why and the results.

What kind of training have your dogs participated in? (Please circle) _ No training

Puppy kindergarten _ Group class: Basic _ Group class: Advanced _ Obedience awards

Herding _ Agility _ Flyball _ Dock Dogs _ Show Dog _ Hunting _ Frisbee Pro _ K9 Cop

Search and Rescue _ Private Training _ Doggie Dancing _ Trained Yourself

Service Dog for :

Other:

What and how often do you feed your dog including treats, table scraps, bones, etc.?

What is your experience with dogs?

Are you healthy? What kind of exercise do you get everyday?

Have you spent extended amounts of time in water before? Please circle:….as a life guard?....a swimmer?....triathlons?....water polo?.....other?

What are you hoping to learn from this dog swimming class?

What other dog classes have you taken? Please circle:....dog massage?....dog behavior?...dog training?....dog nutrition?......how to run a doggie day care?...dog CPR and first aid?.....other?

If you plan to open or have a facility, please tell me all about it, the services you are or will be offering, etc.

Name, dates of class you want to be in and any other options you want:

Rummy's Rules. Please Read and Initial In Front of Each Paragraph:

If you have the flu, a cold or anything contagious - please do not come to this class and get us all sick. We will be happy to confirm you in a future class. We will all be working in close in proximity and intensely in this class – please don’t get us sick.

We take the cleanliness of our pool seriously. We ask you to do the same.

Mark personal items clearly - we cannot be responsible for your personal items.

No food or glass in the pool area. Covered drinks not in glass containers are fine.

Cameras & video cameras are welcome. Any pictures and videos you email us, we try to get on our web site quickly.

Rummy's Legal Stuff. Please Read and Initial In Front of Each Paragraph:

I understand this class does not give me legal license to practice or satisfy any legal requirements of any kind. I further agree to release Rummy’s Beach Club and hold harmless from any and all liabilities and will take classes at my own risk. I understand this is a release of all current and prospective claims and I am of legal age to sign. Should I need to cancel the class, I have read and understand completely how refunds are processed. I understand this contract, which includes the refund policy, may not be amended except in writing and signed by both parties.

I further understand that if an injury caused by me requires treatment as determined by the staff of Rummy’s Beach Club, LLC, I accept full responsibility for financial obligation of treatment to any dog or person injured as a result of my behavior.

I agree that there are inherent risks to me associated with the use of Rummy’s Beach Club, LLC, facilities arising out of or associated with use and conditions, such as swimming, wet floors, multiple dogs and owners and dog behavior. In consideration for Rummy’s Beach Club, LLC granting me permission to use these facilities, I agree to release Rummy’s Beach Club, LLC from liability arising out of or associated with such use, and hereafter waive any and all claims which may arise out of or be associated with such permissive use of the Rummy’s Beach Club, LLC, facilities.

I am (are) responsible for, and agree to provide the canine swim instructor all information requested and agree that I am ultimately responsible for determining whether the warm water dog swimming class provided by Rummy’s Beach Club, LLC is appropriate for me.

A handling fee of $40.00 will be charged on all returned checks. In the event it is necessary to initiate collection proceedings on the account, Client will be responsible for all attorney’s fees and costs of collection.

I, the undersigned, have read this RELEASE and understand all its terms. I execute it voluntarily and with full knowledge of its significance. This agreement has no time limit and is valid and enforceable for any and all future activity with Rummy’s Beach Club and me. The information provided by me is complete and accurate and I agree to all its terms and conditions.

Thank you for taking the time to fill out this lengthy paperwork.

Signature and Date:

Printed Name:

Rummy’s Beach Club, LLC Employee Signature and Date:

Rummy’s Beach Club, LLC Employee Printed Name:

Please make checks payable to:
Rummy’s Beach Club, LLC
22111 Fields Lane, Spring, Texas 77389

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