Tuesday March 17,  2015

RALLY NOVICE  & ADVANCED                                 5:00 – 6:00               $60.00   4 WEEKS
Novice Rally is a relaxed form of Obedience, with different levels of competition. This is the  beginning level which requires that the dog and handler have had previous obedience experience.  Advanced  is the next step, for  the people that have their Rally Novice Title, and want to continue to the next level.

Basic Class                                6:00 - 7:00 PM     $60.00              4 Weeks
This class is for dogs 4 months of age and older, with no formal training. Controlled walking, sit, down,stay & come commands as well as dealing with common problem behaviors.

SHOWHANDLING -                        7:00 – 8:00 PM       $60.00   4 WEEKS
This class is for people who want to show their dog in confirmation at dog shows.

Date________________________Class choice:  Rally_________Basic________Showhandling____



Phone # Home_________________Work__________________email__________________________

Rabies Certificate copy___________________  Date Given_____________________

DHPP/DHLPP (Date) _______________________________________________________________



May we contact your Veterinarian to verify? ____________________________

Dogs Name_____________________________Breed_________________________Age_______Sex_____

(we) agree to hold pocono mt. kennel club, its members, directors, governors,officers and any employees of the a forementioned parties, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by act of this dog,while in or on the dog training premises or grounds or near any entrance and personally assume all responsibility for any claim, i (we) agree to hold the aforementioned parties harmless from any claim for loss of this dog by disappearance, theft,or death and from any claim for damage or injury to the dog caused by negligence of the club or any of the aforementioned parties.  


information: e-mail us on the contact page. 

Please make checks payable to: SROSRC (Stroud Region Open Space & Recreation) no refunds.
Send to:
Pocono Mt. Kennel Club
178 Neyhart Road
 Stroudsburg,Pa 18360


1. I hereby give my permission for my child(ren)/self to participate in the program(s)
on the registration form.
2. I recognize, understand, and acknowledge that, as in all activities, there is always
the inherent risk of injury up to and including death.
3. I recognize, understand, and acknowledge that any and all rules, guidelines, and
safety procedures are established for the safety and protection of all participants and
agree that my child(ren)/self will comply with all rules and policies involved with this program,
and will obey the staff, assistants, and all staff members assigned to direct this program.
4. I certify, to the best of my knowledge, that the current physical condition of my child(ren)
/ self is satisfactory for participation, that the program registrant is free of any health problems
which would jeopardize participation, that I will notify the staff immediately should that condition
change at any time during participation in the program; and that, upon request, I will furnish proof
of current physical examination.
5. SROSRC has a zero tolerance policy with regards to the use of controlled substances,
tobacco products, alcoholic beverages, weapons, and vulgar language.
6. I recognize that failure to comply with the above-mentioned items could result in
immediate suspension and/or dismissal from the program.
7. The staff and/or sponsors have my per-mission to photograph my child(ren)/self. I understand
that these photographs may be used in future promotional brochures, flyers, or news releases.
8. The staff and/or sponsors have my permission to have a physician and/or emergency medical
service treat and/or transport my child(ren)/self , if needed, at any time during participation in the
program(s) on the registration form.
9. In consideration of participation by my child(ren)/self in the program(s) on the registration form,
I, the under-signed, do hereby agree to hold harmless and indemnify the Stroud Region
Open Space and Recreation Commission, its agents, servants, and employees, and all property owners
where the program(s) are held against any claims for and on account of any and all injuries sustained by
my child(ren)/self as a result of participation in the above-mentioned program, including, but not limited to,
claims on account of any negligence by SROSRC or any of its employees, agents, or subcontractors.

Program Registration Form

Rally & Obedience Classes




residence:  Stroud Township - Stroudsburg - East Stroudsburg - other

Date of Birth__________________ Gender:  M  F

Phone: ____________________Email:_________________________________

Medical Conditions/Special Needs:____________________________________

Emergency Contact: ____________________________Phone_______________

Program 1____________________________________Date(s)______________


Program 2____________________________________Date(s)______________

Total Program Fees $ 60.00___
Optional Annual Friends Membership (fill out separate application) $________
Less 5% Membership Discount (total program fees x .05) $________
Total enclosed (make payable to SROSRC) $________
Refund Policy: All refunds must be requested at least ten (10) days before the start of the program; no refunds
will be issued after this deadline. Refunds will be processed within 30 days of request. A $10 service charge will
be assessed on all refund requests. A full refund will be issued if the Commission cancels a program.

I have the read and understand the Notice of Risk and Liability Release.

Signature: ________________________________________________________
(a parent or guardian must sign for anyone under 18 years of age)
Notice of Risk and