2. North Myrtle Beach Police K9 Skills Competition

   
   

4. Participant’s Information

6. Name*
7. Phone Number*
9. Address*
10. City*
12. State/Zip Code*
13. Years as Handler*
14. Email Address*
16. Shirt Size*
17. Select a competition category*
    -- Select One --CivilianLaw Enforcement

19. Agency Information

21. Agency Name*
22. Agency Phone Number*
24. Agency Address*
25. Agency City*
27. Agency State/Zip Code*
28. Years with Agency*

30. K9 Partner Information

32. K9 Name*
33. K9 Age*
35. K9 Breed*
36. What odor is your partner trained on?
    -- Select One --NarcoticsExplosivesOther*

38. *If not narcotics or explosives, competitor will need to provide training aid.

40. Emergency Contact

42. Emergency Contact Name*
43. Emergency Contact Phone Number*

45. Course Participation

47. Circle courses your team wishes to participate in*

    1. Agility
    2. Hardest Dog

    1. Fastest Dog
    2. Scent Detection

49. General Information

51. Tell us about your dog (what motivates them, favorite activity, etc)*
53. List any noteworthy statistics
55. Will you and your partner participate in public meet and greets? *
    -- Select One --YesNo

57. Authorization Form and Release of Liability

59. • I agree to waive and release the North Myrtle Beach Police Department, the City of North Myrtle Beach, and each of their directors, officers, agencies, and employees from liability for all claims for damage or loss to my person or property which may be caused by any act or failure to act on the part of the City.
    • I agree that if any claim is commenced against the City based on acts that I take or fail to take, I will defend, indemnify, and save the City harmless from any and all claims or causes of action, injuries, or damages.
    • I acknowledge, understand, and assume all risks related to the participation in the North Myrtle Beach Police K9 Skills Competition. I understand that these activities may present risk of serious danger to my person (including death) and to my property. These risks and dangers may be caused by my negligence or the negligence of others including other participants, instructors, supervisors and city officials or employees. I further acknowledge that there may be risks and dangers not known to the City or not reasonably foreseeable at this time. I acknowledge, understand, and agree that all the risks and dangers (regardless of whether specifically described in this agreement or not) however caused are included within this waiver of liability release and indemnification agreement. I waive any and all specific notice of such risks or potentially dangerous conditions.
    • I acknowledge, understand and assume the risk arising from the skills competition as well as the conditions of the areas and related premises and I acknowledge and understand that included within the scope of this waiver and release are any causes of action arising from the maintenance, inspection, supervision or control of said areas, or the failure to maintain, inspect, supervise or control said area and for failure to warn of dangerous conditions existing at the qualification area (known or unknown).
    • I understand and agree that the parts of this Agreement are severable and that should any part of this agreement be declared unenforceable, the remainder of this agreement shall nevertheless remain in effect and enforceable to the full extent allowed by law. I understand that I have the right to consult an attorney of my choice, at my own expense, before I sign this agreement.
    • I agree that this Agreement is binding on my agents, heirs and assigns.
    • I certify that l am 18 years of age, or older, and that I am competent to make this Agreement.
    • I acknowledge that I have been provided with this Agreement before start of the qualification session and I have not relied upon any contrary representations expressed or implied of any matter covered by or in any way related to this Agreement.
61. 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.

    3) You may still be required to provide a traditional signature at a later date. 

    4) You hereby understand and agree to the text above

    1. I agree.
63. Electronic Signature*
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field