REGISTRATION FORM

2017 NAPWDA Florida State Workshop

December 4 – 8, 2017

REGISTRATION IS NOW OPEN

One handler/one dog per form.

Fax completed form to 321-264-7876 or scan & email to

PAYMENT BY CHECK ONLY – WORKING ON A CREDIT OPTION

SEE WORKSHOP INFORMATION SHEET for DETAILS & PAYMENT INFO

IMPORTANT: PLEASE PRINT CLEARLY
Name:
Agency:
Address:
City: / State: / ZIP:
work phone: / cell:
email:
T-shirt size: /

S M L XL

/

2X

/

3X

K-9 Name: / /

Breed:

/
How many years/months have you worked with this K-9?
K9 shirt size (circle) S 5-10 lbs, M 11-23 lbs, L 24-45 lbs, XL 46-70 lbs, 2XL 71-85 lbs, 3XL 85+ lbs

Purpose of attending: Training only Certification (new) Certification (renewal)

Please check all that apply:

Purpose / Certification / Training / Purpose / Certification / Training
Patrol / Tracking
Narcotics / Cadaver/HRD
Area Search / Trailing up to 1.5 mile
Dual Purpose / Explosives
Aggression / Obedience
Waiver: The undersigned participant recognizes the possibility of injury occurring as a result of his/her participation in the K9 Workshop. I furthermore state that my canine and I are in a physical condition necessary to be able to participate in the events, as needed for training and certification purposes. I hereby waive and relinquish the North American Police Work Dog Association, further referred to as NAPWDA, the Brevard County Sheriff’s Office and the Titusville Police department, their affiliates, sponsors, organizers, and or all participants, for any injury, mental or physical, to myself or my canine. I also agree to abide by all rules and regulations as set forth by NAPWDA and the event organizers. I furthermore will accept responsibility for any damage caused by my canine or myself to any and all property, persons and to include the hotel accommodations and or any training venue.
If you decide to consume any alcoholic beverage during the workshop week, you do so at your own risk. If you do drink an alcoholic beverage please doso in a responsible manner and Don't Drink and Drive.
Date: ______/______/______Sign Name: ______
Print Name: ______