ORT Registration

Location: Waller School 195 Gardner Ave, Burlington, WI 53105

Start time: 9:00am

We will run all birch runs first, then anise, then clove.

If you wish to run two dogs you will have to register them seperately.

Your Email*

example@example.com

Best Phone Number to contact you if needed*

Please enter a valid phone number.

NACSW MEMBER ID # - Starts with a M......*

Your LAST name*

Your FIRST name*

NACSW DOG ID# - Starts with a K......

Dogs Name*

What is your dogs breed?*

WAIVER OF LIABILITY ANDINFORMED CONSENT --- I understand that participating in the ORT (the “Event”), whether as a participant, a volunteer or a spectator, holds some risk. These risks include, but are not limited to, that the behavior of dogs and other domestic animals is sometimes unpredictable, cannot be guaranteed, and can result in serious personal injury or death to bystanders, as well as extensive property damage. In addition, I and/or my dog may be exposed to challenging, treacherous or unstable terrain and footing during the Event. Acknowledging my awareness of the risks associated with participating or observing any type of detection style training or competition, I hereby waive and release any claim or cause of action that I may otherwise have against Laura Yurchak and Loving Paws Dog Training LLC, Waller School and their respective employees, officers, directors, agents, or contractors(collectively, the “Released Parties”) for any claim or cause of action for personal injury or property damage (collectively, a “Claim”) arising out of or in connection with events, accidents or other occurrences at the Event, except to the extent that the Claim arises out of the intentional misconduct or gross negligence of the Released Party. I further agree to defend, indemnify, and hold harmless each Released Party from and against any and all claims, damages, costs and expenses arising out of or in connection with any Claim that is based, in whole or in part, on acts or omissions by me or by any person or animal for whom or for which I have or had responsibility or control. 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 OR if I have had symptoms, I am now symptom free and have had a negative test; 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 OR if I have been in contact with a known carrier, I have had a negative test. I am representing my condition as of signing, and if, as of the later time of the event, there had 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 participation in this event. I agree to follow any specific event guidelines, precautions and requirements to mitigate the possibility of event participants or attendees contracting or spreadingCOVID-19. I understand the risks of contracting or being exposed to COVID-19associated with my attendance at this event, and I knowingly accept those risks. I agree to waive, release and hold harmless all Released Parties from and against any claim, liability, loss or expense arising from or 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. Participation in this event requires adherence to all host, facility, and jurisdictional guidelines and requirements relating to COVID-19. This may include testing, vaccinations, quarantines, temperature checks and other safety measures. I have read, understand and agree to the above:*

Clear

Birch run - $35

Birch

Anise Run - $35

Anise

Clove Run - $35

Clove

PAYING BY CHECK*

YesNo

IF PAYING BY CHECK - please send check to address below and click on submit below.

Loving Paws LLC

4816-67th St

Kenosha, WI 53142

USE IF PAYING BY CREDIT CARD ONLY

One Odor being ranRunning one dog in one odor.

$35.00

Two Odors being ranRunning one dog on two odors.

$70.00

Three Odors being ran.Running one dog on all three odors.

$105.00

Total

$0.00

Odor Recognition Test - ORT