ORT Registration & NACSW Liability Waiver September 11, 2022

NACSW Liability WAIVER
We are looking forward to an awesome ORT on Sunday, September 11, 2022.

Please Complete Registration, NACSW Liability Waiver and payment.

Happy Sniffin'

Nancy Reyes, Host

Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number

Area CodePhone Number

NACSW MEMBER #*
DOG'S NAME*
DOG'S BREED*
DOG'S GENDER*
DOG'S NACSW #*

Please choose the odors you want to test for this dog. You may enter a second dog but must register it separately.

My Products

Birch$30.00

Anise$30.00

Clove$30.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

National Association of Canine Scent Work, LLC® Liability Waiver

WAIVER OF LIABILITY AND INFORMED CONSENT
Name

First NameLast Name
Email
example@example.com
I understand that the behavior of dogs cannot be guaranteed. I also understand that the behavior of domestic animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious personal injury or death, as well as extensive property damage. Knowing the risks I agree to assume ALL those risks including, but not limited to; assuming the financial responsibility of any possible litigation arising from any incident in which I may be involved. I release, indemnify, and hold harmless Amy Herot, Jill-Marie O’Brien, Ron Gaunt, K9 Nose Work®, National Association of Canine Scent Work, LLC®, For Your K9, Nancy Reyes, and their Employees, Officers, Directors, Agents, or Contractors from any and all damages or personal injury. Any incident involving myself, the location, or those pets or actions of other participants and spectators will be my sole responsibility and I assume all financial liability and will also assume all and any financial costs associated with my actions.*

YesNo
I represent and affirm that to the best of my knowledge and belief: (1) I do not have COVID-19 nor am I waiting for test results; (2) I have not been tested and found positive for COVID-19 or if I have tested positive for COVID-19, I certify that I have been released by government officials and/or health care providers to resume normal activity without limit; (3) I have not during the past 14 days experienced symptoms associated with COVID-19 including fever, coughing, or shortness of breath; and (4) I have not within the past 14 days, to the best of my knowledge and belief, been in contact with or exposed to any known carrier of COVID-19. . I am representing my condition as of signing, and if, as of the later time of the event, there has been any change in any of the conditions represented, I am obligated to formally notify the event host of the changed conditions at the time of and before participating in the event. I agree to follow any specific event guidelines, precautions and requirements to mitigate the possibility of event participants or attendees contracting or spreading COVID-19. I understand the risks of contracting or being exposed to COVID-19 associated with my attendance at this event, and I knowingly accept those risks. I agree to waive, release and hold harmless K9 Nose Work®, National Association of Canine Scent Work, LLC®, Amy Herot, Jill-Marie O’Brien, Nancy Reyes/For Your K9, the event location’s agents or owners, and each of their respective employees, officers, directors, agents, or contractors from and against any claim, liability, loss or expense arising out of based upon a COVID-19 infection acquired by myself or any of my family members or associates as a result of or contemporaneous with attendance or participation at this event. Initials*
In addition to the above, I understand that participating in this event, even as a volunteer or spectator, holds some risk. My dog and I may be exposed to challenging, treacherous or unstable footing and accept all possible risks associated with participating or observing any type of detection style training or competition. I agree to hold harmless Amy Herot, Jill-Marie O’Brien, Ron Gaunt, K9 Nose Work®, National Association of Canine Scent Work, LLC®, For Your K9, Nancy Reyes, and their Employees, Officers, Directors, Agents, or Contractors including, but not limited to, the event location’s agents or owner and to accept responsibility for all litigation and financial obligations arising from any unforeseen event in which I may be involved.*

YesNo
I have read, understand and agree to the above: *
Name (Print)
Signature (Sign with your finger or a mouse)*

Clear
Date*

MonthDayYear
Date
Name of dogs at event location*
Parental Consent (Minor Competitors)
YesNo
Parental Consent: I am the lawful parent and/or legal guardian of the above named minor. I acknowledge that I have read and understand this Liability Waiver and that I and the above named minor will be bound by said Liability Waiver.
Name (Print)
Parental Consent Date

MonthDayYear
Date
Parental Consent Signature

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NACSW Liability WAIVER

National Association of Canine Scent Work, LLC® Liability Waiver

Parental Consent (Minor Competitors)