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2. 2021 NAPWDA Florida State Workshop Registration Form

   Hosted by: Titusville Police Department & Brevard County Sheriff’s Office

   REFER TO THE “WORKSHOP & REGISTRATION INFORMATION SHEET”

   FOR PAYMENT DETAILS AND OTHER IMPORTANT INFORMATION, VISIT https://www.titusville.com/1098/5684/NAPWDA-2021?activeLiveTab=widgets

   Register now - Pay Later

   Registration is limited and expected to fill up.

   One Handler/one dog per form.

   
   

4. Name:
6. Agency:
8. Address:
10. City:
12. State:
13. ZIP:
15. Work Phone:
16. Cell:
18. Email:
20. T-Shirt Size:

    1. S
    2. M
    3. L
    4. XL
    5. 2X
    6. 3X
22. K-9 Name:
24. Breed:
26. How long have you worked as a team with this K-9?
28. Years
29. Months
31. Purpose for Attending:

    1. Training Only
    2. Certification (New)
    3. Certification (Renewal)
33. Please check all that apply:
35. (NOTE: This workshop's main focus is certification)

    1. Patrol Certification
    2. Patrol Training
    3. Narcotics Certification
    4. Narcotics Training
    5. Area Search Certification
    6. Area Search Training
    7. Dual Purpose Certification
    8. Dual Purpose Training
    9. FDLE Certification
    10. Tracking Certification
    11. Tracking Training
    12. Cadaver/HRD Certification
    13. Cadaver/HRD Training
    14. Trailing Up to 1.5 Mile Certification
    15. Trailing Up to 1.5 Mile Training
    16. Explosives Certification
    17. Explosives Training
    18. Aggression Problem Solving
    19. Obedience Problem Solving
37. Waiver:

    As the undersigned participant, I recognize the possibility of injury occurring as a result of my 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, 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 or persons 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 do so in a responsible manner and Don't Drink and Drive. <<

39. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. Electronic Signature
43. Name:
45. Date:
    Date:
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field