Participant’s Registration: (Please Print)
Last Name:
______________________________________ First Name: ___________________________________
Affiliation:
____________________________________________________________________________________
Mailing
Address: _______________________________________________________________________________
City:
Home Phone:
____________________________________ Cell Phone:
___________________________________
Email
Address: _________________________________________________________
YES! Please send me an
email confirmation of my registration!
Dog Registration:
Dog’s Name:
_____________________________________ Breed: _______________________________________
Age:
__________________ Specialty:
______________________________________________________________
** Please
include a copy of your shot records including Rabies, Bordetella,
and DHLP or titer results taken within the past year if you do not vaccinate.
All dogs from out of state are required to have a canine health certificate
with them at the seminar. We strongly suggest that your canine be on heartworm,
flea and tick prevention.
Emergency Contact:
Last Name:
_____________________________________ First Name:___________________________________
Home Phone:
___________________________________ Cell
Phone: ___________________________________
Work Phone: ___________________________________ Pager: _______________________________________
Select the primary class that you plan on
attending:
![]()
![]()
![]()
Tracking/Trailing
Select a level: Beginner
Intermed. Advanced
![]()
![]()
![]()
Airscent Select a level: Beginner
Intermed. Advanced
![]()
![]()
![]()
Land Cadaver Select
a level: Beginner Intermed. Advanced
![]()
![]()
Water Cadaver Select a level: Beginner Advanced
Article Search (if available)
Deposits: Due
by
Amount Enclosed:
$100.00 Deposit due by Dec. 15th (with registration)- the remainder due at registration).
$250.00 Full Amount
Special Requests:
_____ I would like to share a cabin with, Group(s): ____________________________________________________
Names:
_________________________________________________________________________________
_____ If available, I would like
to request a lower cabin, more centrally located, due to my age or Limited
physical abilities, not just for convenience.
_____ I have special diet requirements. Please specify:
________________________________________________
(We will try to accommodate special dietary requirements,
but are not guaranteeing that we can accommodate them all or to the
specifications of the attendees. Please be prepared in the case that we can
not.)
Sleeping
Arrangements: (8 or 9 bunks per
cabin, all cabins are winterized, shower and toilet facilities)
-Seminar price
does not change if you are “not” staying in cabins provided by
_____ Bunker style Cabins “with” your dogs inside, 18-20 per cabin.
_____ Bunker style Cabins “without” your dogs, but allowed in crates on porch, sleeps 18-20
per cabin.
I, ____________________________________________________, the undersigned,
having requested the right to participate in a seminar hosted by Central
Georgia K9 Search and Rescue, Inc. Such an enrollment having been made of my
own initiative, and I, specifically understand and acknowledge that I am aware
that there are inherent dangers and risks in the training and evaluation of
handlers and their canines, and I fully understand that if I am to participate
in the seminar, I accept the inherent dangers and risks to me and my canine(s).
Now, therefore, in consideration for permitting me to participate in such
training and/or activities, I hereby waive and release instructors, individual
members of CGK9SAR and/or Camp Kaleo, from all
claims, rights or causes of actions accruing in my favor as a result of
personal injuries or loss or damage of property (including my canine(s) caused
during such training or activity in conjunction with this 2008 January 21-25
Seminar, including arrival and departure dates and such waiver and release
shall apply on behalf of myself and all who my hereafter claim through or for
me.
Signature of Participant:
_____________________________________________ Date: ______________________
Property
Damage Agreement
My signature above also indicates that I understand that I am
responsible for any and all damages causes by me and/or my canine(s), including
by not limited to, property damage and/or injuries to individuals and/or their
canine(s) during my activities associated with the seminar sponsored by CGK9SAR
scheduled for January 21-25, 2008. In addition to the aforementioned payment of
damages, said individual(s) and their canine(s) in violation of this agreement
may be expelled from the training or activity with no refund.
Facility rules that
participants further agrees to:
·
All canines shall be on leash or crated, except
when they are being worked.
·
All canines shall be off lead only while under
supervision of an instructor and at their direction to do so.
·
You must clean up after your dog in wooded and
non-wooded areas.
·
You must bring a crate or a pen for your dog, no
tie outs.
· Dogs are not allowed in the dinning area.
·
No alcohol or tobacco products on camp grounds.
·
You must be familiar with your outside lodging
facilities’ pet policies and abide by them.
·
You assume full responsibility for any other
person(s) attending the seminar.
·
You seminar host(s) will not be responsible for
any loss, injury, or death to any person or animal while in attendance at the
seminar.
Signature of Participant:
_____________________________________________ Date: ______________________
Mail completed
Registration and payment to:
Dee Park -
Registration:
·
Please be aware that check-in time will be
Sunday January 20th after
·
Follow signs to Registration.
· Breakfast, Lunch, and Dinner will be served from Monday morning through Friday morning.
· Sunday night meals will not be provided.
·
If you have any items for the silent auction,
all items will be greatly appreciated.