Registration for Personalized Private Instruction
City:_________________________________ State:__________________ Zip:________
Requested days/dates of instruction:_________________________________________
What I want to learn during my day(s) of Personalized Private Instruction:________________________________________________________________________
Give me some background in the grooming field:_______________________________
- $350.00 for a half day to shadow
-$550.00 for a full day of hands on grooming
To schedule any PPI days, a 50% non-refundable deposit is required. The remaining balance is due 1 week before the first day of your hands on instruction.
check___ (Payable to Fuzzy Butts, LLC) Email invoice Requested___
Visa___ MasterCard___ Discover Card___
CC #________________________________________________Expiration Date_____________
Security Code on Back________ Cardholder Signature___________________________________
By submitting this form and payment for PPI, I understand that I am registered for the dates listed above and that all fees for instruction are non-refundable. I have read and agree to the terms of the Personalized Private Instruction as provided to me.
Hold Harmless Agreement
Fuzzy Butts, LLC and trainee acknowledge that there is some risk of accident or injury associated with the use of equipment and other aspects of the course of study, including but not limited to direct care and contact with cats during hands-on grooming instruction. Student does hereby waive, release and discharge Fuzzy Butts of any and all liability and all claims for damages for death, personal injury, or property damage which I may have or which hereafter accrue to me as a result of participation in the program whether or not caused by negligence or fault of Fuzzy Butts, LLC.
This release is intended to discharge Fuzzy Butts, and its officers, employees or representatives, volunteers and agents from and against any and all liability arising out of or connected in any way with my participation in the training, internship/externship, hands-on activities, practice, and other activities.
Knowing risks exist, nevertheless, I hereby agree to assume those risks and to release and to hold harmless all persons or agencies mentioned above who might otherwise be liable to me or my heirs or assigns for damages. I further understand and agree that this waiver, release, and assumption of risk to be binding on my heirs and assigns.
In addition, I give permission to receive, if necessary, emergency medical services by authorized personnel, and that any cost incurred as a result of such medical treatment will be my responsibility.
Emergency Contact:______________________ Phone____________________
Relationship to trainee______________________________________________
Trainee Signature:__________________________________ Date:___________