Clone of Dog Class Training Registration Form

Full Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

Phone Number

Auditing Spot

Working Spot Note:Price includes one Day Auditing and One Day Working

Name of Dog

Age of Dog

Breed of Dog

Sex of Dog

MaleFemale

Nosework Experience: How many months/years?

Have you participated in Nosework events?

YesNo

What Kind of Training?

What types of NACSW Nosework Trials have you participated in?

What types of Sniffing Dog Sport Trials have you participated in?

What types of AKC trials have you participated in?

Other Trials? Please describe.

Is your dog able to rest comfortably in your vehicle without barking when he/she is not working?

YesNo

Does your dog have any health or behavior issues?

Are you a NACSW CNWI?

YesNo

Are you a member of CCPDT?

YesNo

If yes, what is your CCPDT Membership Number?

____ I Agree

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 Dana Zinn, Candace Bennyi, Laura Camodeca, Out & About With Your Dogs, Flying Cloud Farm and their Employees, Officers, Directors, Agents, or Contractors from any and all damages or personal injury. Any incident involving the above, including Flying Cloud Farm, or the pets or actions of other participants and spectators will be my sole responsibility. I assume all financial liability and will also assume all and any financial costs associated with my actions.

____ I Agree

In addition to the above, I understand that participating in this event, even as a volunteer, auditor, or spectator holds some risk. I may be exposed to challenging, treacherous or unstable footing, and I accept all possible risks associated with participating or observing any type of training in the workshop. I agree to hold harmless Dana Zinn, Candace Bennyi, Laura Camodeca, Out & About With Your Dogs, Flying Cloud Farm, and their Employees, Officers, Directors, Agents, or Contractors including, but not limited to the and owners of Flying Cloud Farm. Any incident involving myself and the event location or actions of other participants, spectators, or volunteers will be my sole responsibility. I accept and assume responsibility for all litigation and financial obligations arising from any unforeseen event in which I may be involved.

____ I Agree

I acknowledge that my dog is in good health and is able to participate in this workshop with other dogs and people. My dog is current on all vaccinations determined by local ordinances and my veterinarian. I release indemnity and hold harmless Dana Zinn, Candace Bennyi, Out & About With Your Dogs, Laura Camodeca, and any and all volunteers, agents, and contractors including the owners and agents of Flying Cloud farm from all damages or injury.

____ I Agree

I understand that video recordings or photographs may be taken at the workshop. I also understand that these videos/photographs may be used for educational or public purposes.

I have read, understand and agree to the above:

Date Signed

Date

Signature*

Sign by using a touch tablet/screen or left click and hold as you sign with your mouse.

SIGN ME UP!

Click the Submit button below to submit your online application to Out and About With Your Dog. Once your application is received, please await a response with confirmation of your place in class and instructions on payment.

Handler Information

Registration Preference

Dog Information

Continuing Education Units (CEU)

Release of Liability and Informed Consent