INDEPENDENCE ELITE & NW3 -  Liability Waiver & Payment Link - APR 27 & 28, 2024
PERRYDALE SCHOOL, 7445 PERRYDALE RD, AMITY, OR
Sign in to Google to save your progress. Learn more
Email *
I understand that participating in a K9 Nose Work Trial, (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 sometimes 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. *
Required
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®, Helix Fairweather, Doglandia LLC, Kristina Leipzig, Perrydale School District, 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. *
Required
I represent and affirm that to the best of my knowledge and belief: (1) I do not have COVID-19 nor am I waiting for test results; (2) I have not been tested and found positive for COVID-19 or if I have tested positive for COVID-19, I certify that I have been released by government officials and/or health care providers to resume normal activity without limit; (3) If I have experienced symptoms associated with COVID-19 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. *
Required
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 a COVID-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. *
Required
Participation in NACSW events requires adherence to all host, facility, and jurisdictional guidelines and requirements relating to COVID-19. This may include testing, vaccinations, quarantines, temperature checks and other safety measures. *
Required
Your Name *
Provide your digital signature in order to indicate your agreement to these terms. Your digital signature can be any combination of letters, numbers, spaces and/or punctuation marks placed between two forward slash " / " symbols. Examples of acceptable signatures include /365-2014/, /jd/ and /john doe/. I have read, understand and agree to the above: *
Name of dogs at event location. If you will be at the event more than one day with a different dog, enter all dog names here. If you are volunteering and will not be traveling with a dog, enter "none." *
Parental Consent (only required if you are the parent of the person above who is a minor)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. Signature below verifies I have read, understand and agree to the above. Provide your digital signature in order to indicate your agreement to these terms. Your digital signature can be any combination of letters, numbers, spaces and/or punctuation marks placed between two forward slash " / " symbols. Examples of acceptable signatures include /365-2014/, /jd/ and /john doe/.
Please verify attendance policies with the host before bringing or inviting anyone not volunteering, competing, or officiating.

perrydale.trial.2023@gmail.com  Your guest(s) must also fill out this liability waiver.
*
Required
PAYMENT INFORMATION  FOR HANDLERS IS A LINK ON THE PAGE THAT IS DISPLAYED AFTER YOU CLICK "SUBMIT". AS A HANDLER, I UNDERSTAND AND WILL LOOK FOR THAT LINK ON THE FOLLOWING PAGE. *
Required
Today's Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy