Membership Renewal Form

Clermont County Dog Training Club, Inc.
Membership Renewal Form
10/1/22 - 9/30/23

* Indicates required field

Name(s) (Adults) *

First

Last

Name(s) (Juniors) *

First

Last

Address *

City *

State, Zip *

Preferred Phone Number *

Email *

Dog Breed(s) *

Please check type of membership: *

Single: 1 adult over 18. Dues $45 with 16 service hours. Single Senior: 1 adult 60 years or older. Dues $41 with 16 service hours. Family: 2 adults, can also include any children under 21 yr. old. $55 with 22 service hours. Family Senior: 2 adults 60 years or older. Dues $50 with 22 service hours. Family Junior: 1 adult with children under 18 yrs old. Dues $45 with 16 service hours. Lifetime: Louisa Flood Award winners. $0 with 0 service hours. Lifetime Family: Louisa Flood Award winners plus family members. Dues $10 with 16 service hours. Pays cleaning fee Inactive: Requires Board approval. Dues $0 with 0 service hours. No Cleaning Fee Inactive Lifetime: Requires Board approval. Dues $0 with 0 service hours. No Cleaning Fee.

NOTE: Cleaning Fee is NOT included in Dues.
They are $20 single or $30 family.

Service hours information: 10/1/21 through 9/30/22. A fee of $15 for each required service hour not worked must be added to a member's dues. *

YES, I have worked my required service hours for this year. NO, I have not worked my required service hours for this year.

# hours not worked: *

Based on the type of membership you checked, please complete the following:

Membership amount due: *

Service hours fee (if applicable): *

PLUS Cleaning Fee ($20 single/$30 family): *

Total amount to be paid: *

Dues still not paid by October 1, 2022 will be considered lapsed. If Dues and or Fees are still not paid by
November 1, 2022 membership will be terminated.

Volunteer Opportunities
Check all ways you wish to help the club and earn service hours. No need to be an expert. Training will be provided as needed.

Other classes: *

Other ideas you have to help the club: *

I hereby release and agree to hold harmless the Clermont County Dog Training Club, Inc., its instructors, trustees and officers from personal injury, damages or injury to myself, my family or any dog owned by me; including any liability, cost or expenses associated with the foregoing, arising out of, or during training classes or other activities sponsored by CCDTC, Inc. In addition, I understand that it is my responsibility to keep my dog(s) under control at all times before, during, and after classes or events, and to refrain from harsh or abusive training methods at any CCDTC, Inc. activity. I certify that any dog I bring to the CCDTC building is healthy and Appropriately Vaccinated.

All adult Members must provide release signatures (type names in boxes) *

Membership renewals are due by October 1, 2022.

Dues still not paid by November 1, 2022 will be considered lapsed and membership will be terminated.
Please make checks payable to CCDTC.

CCDTC Board Approved July 2022

By clicking Submit below your membership form will be sent to the Membership Chairman. Your check needs to mailed or hand delivered to the club.

Clermont County Dog Training Club, Inc.​Membership Renewal Form​10/1/22 - 9/30/23

Clermont County Dog Training Club, Inc.
Membership Renewal Form
10/1/22 - 9/30/23