CMRA Decoy Certification Candidate Application

Last Tetanus Shot Date

MonthDayYear
Date
Doctor's Name

First NameLast Name
Doctor's contact information - Phone or Email. You will need to attach an approval from your doctor stating you are able to participate in "Contact Sports"
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

DECOY CERTIFICATION EVENT INFORMATION
Certification Event Date

MonthDayYear
Date
Club Hosting Certification
Dog(s) you are requesting to use. Dog Name, Titles, Handler's Name, Handler's Contact Info
By submitting this application, I agree to abide by the CMRA Code of Conduct, rules and regulations of the CMRA (Canadian Mondio Ring Association) and its stated purposes of promoting Mondioring, sportsmanlike conduct and fair and humane training at all dog sport activities. I agree to keep myself informed on current by-laws, CMRA Code of Conduct and policies and procedures of CMRA via the www.canadianmondioring.org website or by requesting a copy from the CMRA Secretary. I am aware of the inherent risks of decoy acitivits, and hold the CMRA harmless for any medical expenses or other losses I incur as the result of my participation in the certification or future activities as a CMRA decoy. I also agree that I will send a copy of my doctor's note to the CMRA Secretary as well as my current decoy book pages at the end of each year.
Signature
Date

MonthDayYear
Date
ATTACH Doctor's Note of Medical Clearance for Candidate to participate in "Contact Sports"

Cancelof
Copy of Decoy Book Pages

Cancelof
Should be Empty:

DECOY CERTIFICATION EVENT INFORMATION