EWWBK SUMMER CAMP Thursday July 2nd- Sunday the 5th 2009
REGISTRATION FORM
Send to: EWWBK c/o Minna Nousiainen-Becher N1036 Mink Lane Campbellsport, WI 53010
Phone: (920)533-5345 E-mail: boxnen@gmail.com
CAMPER 1 NAME: ___________________________________________ I will camp in a (circle) Tent, Camper, Hotel
Are you a previous EWWBK Summer Camper? _______ No _______ Yes, if yes list year(s): _______________________
How many dogs are you working and what are you interested in working with your dog(s)? _________________________
___________________________________________________________________________________________________
CAMPER 2 NAME: ___________________________________________
Working participant? (Circle)Yes or No.
Are you a previous EWWBK Summer Camper? ____ No ____ Yes, if yes list year(s): _____________________________
Address: _________________________________ City: _______________________ State & ZIP: ___________________
Home Phone: (______)____________________ Cell: (_____)___________ E-mail: _______________________________
Emergency contact: ________________________________________________ Phone: (_______)____________________
Camper 1 is (circle) a EWWBK and/or USA-BOX member. USA-BOX membership #: _____________
Camper 2 (ATTN. if you are a spouse and not a working participant, you are not required to be a member of USA-BOX to join the camp) If you are a USA-BOX member put your USA-BOX membership # here: ____________
1st Dog’s Name: ____________________________________ Breed: ___________________________ Age: ___________
2nd Dog’s Name: ____________________________________ Breed: __________________________ Age: ____________
Two dogs are allowed per handler, extra dogs add $50 to total. Only if dog is being worked. Pet dogs no charge.
3rd Dog’s Name: ______________________________________ Breed:________________________ Age: ____________
4th Dog’s Name: ______________________________________ Breed: ________________________ Age: ____________
Check here:
____ Non-refundable $100 deposit for working participant (Deposit applies to camp fee.) $ ________
____ Non-refundable spouse fee (if apply) $50 deposit for non working participant (No other charge apply.) $ ________
____ EXTRA DOG(s) 3rd dog $50, plus 4th dog $25 to total $________
Check enclosed. (Please make checks payable to EEWBK on memo please type “Summer Camp 2009”)
Total paid & Date ..…………………………………………………………………………………Date:_______ $ _______
Balance due ………………………………………………………………………………………………………. $ ________
Participation Agreement and waiver: I approve this application and certify that the applicant is capable of such experience. I agree to pay the balance of the camp fees 3 weeks prior to the start of the session (we cannot hold reserved space past that date without full payment). That date is June 11th 2009. Camp fees are not refundable without a doctor’s authorized medical reason (this is for people). I understand that no refunds are given if participant has to leave early for disruptive behavior as determined by EWWBK board and Camp Director. The deposit is not refundable or transferable under any circumstances. EWWBK nor USA-BOX is not responsible for lost, stolen or damaged personal belongings. I also authorize the EWWBK to have and use photographs, slides, video tapes of the person(s) and dog(s) named in this application as may be needed for its public relations programs.
I hereby waive, release and discharge any and all claims for damages or death, personal injury, and/ or property damages which I, or my heirs, may have, or which may subsequently accrue to me or my heirs, as result of or arising from my participation in any subject training session. This Release and Waiver is intended to, and shall operate to, discharge in advance the officers, members, promoters, sponsors, officials, land owners, and other participants and guests from and against any and all liability arising out of or connected in any way with my participation in the EWWBK Summer Camp 2009, even though that liability may arise out of negligence or carelessness on the part of any person or entity above mentioned.
I HAVE READ AND I AM IN AGREEMENT WITH THE TERMS OF THIS RELEASE AND UNDERSTAND THAT BY SIGNING THIS RELEASE I AM RELINQUISHING AND WAIVING CERTAIN LEAGAL RIGHTS I OTHERWISE WOULD HAVE.
Camper 1 Signature __________________________________________________Date: ___________
Camper 2 Signature __________________________________________________ Date: __________
(Camp personnel ONLY: PAID IN FULL Date: _______received date here: ________ Vaccines: __________
De-Wormer _________
_____ a copy of vaccines send in with this application. Dog must have proof of 2 DHLP vaccines and be current or rabies vaccine
_____ Camper read the INFO sheet about camp rules etc. and signed in______
This second page is for any comments and such:
Please feel free to write here what you want to work on at the camp by #1 being most important.
Ex. #1 Schutzhund (Please indicate the level your dog is at and what you think you need more help with).
#2 Agility (=contacts and weaves)
#3Also Conformation.
OR
#1 Schutzhund. I need help with control in protection. Attention and focus I obedience. How to start tracking.
Also please write your level of experience in anything to do with dogs and level of training. Dogs and titles you have earned so far etc. So that we would be able to create proper groups to put you at the camp.
Thanks Camp Director – Minna N-B.