Canoga Park Odor Recognition Test November 9, 2024 Entry and Waiver of Liability & Informed Consent
National Association of Canine Scent Work, LLC®
Handler's Name
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First Name
Last Name
Handler's NACSW Member Number
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Handler's Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
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example@example.com
Phone Number where you can be easily reached
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-
Area Code
Phone Number
Emergency Contact Name
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First Name
Last Name
Emergency Contact Phone Number
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Area Code
Phone Number
Dog's Call Name
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Breed(s)
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Dog's NACSW Registration Number
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ODOR SELECTIONS - please select which odor(s) you would like to test. Cost is $38 per odor
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BIRCH
ANISE
CLOVE
I agree (check box)
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I understand that participating in Pink Biscuit K9s 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 some times 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.
I agree (check box)
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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 Amy Herot, Jill-Marie O’Brien, K9 Nose Work®, National Association of Canine Scent Work, LLC®, Pink Biscuit K9s, Deann Hobson, Dawn Marando, 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 agree (check box)
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In addition to the above, I acknowledge that my pet is in good health and is able to participate at this event with other dogs and people. I release, indemnify and hold harmless Amy Herot, Jill-Marie O’Brien, K9 Nose Work®, National Association of Canine Scent Work, LLC®, Pink Biscuit K9s, Deann Hobson, Dawn Marando and any and all volunteers, agents or contractors from all damages or injury.
I agree (check box)
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I represent and affirm to notify Pink Biscuit K9s if I have experienced symptoms associated with COVID-19 the week prior to the ORT including fever, coughing, or shortness of breath or if I have been in contact with or exposed to any known carrier of COVID-19, I have met the current CDC recommendations regarding testing and/or quarantine.
I agree (check box)
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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 all Released Parties from and against any claim, liability, loss or expense arising from or based upon aCOVID-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.
I agree (check box)
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In addition to the above, Any incident involving myself, the location, or other 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. If I am to bring another person to assist me to this event , I affirm and take full responsibility for their health and well-being.
Agreement
I have read, understand and agree to the above:
Signature (use mouse or finger)
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Today's date
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Minor's name
Parent's name
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.
Parent signature
Click HERE To Submit Entry Form
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