ORT Registration Form to Print

Pawsitive Training Zone

NACSW™ – Odor Recognition Test

Saturday, October 19, 2019

American Legion Post 759, 206 West Chestnut Street, Chatham, IL  62629

$35 Registration Fee Per Test - Payment by check or money order if mailed in US Mail.  

Please mail this completed form via US Mail with your registration fee to:

Pawsitive Training Zone, 145 North Market Street, Chatham, IL  62629

Questions: Contact Sandra Carbonell, Email:  pawsitivetrainingzone@gmail.com

Odor:   □ Birch                    □ Anise                 □ Clove

Test date:   Saturday, October 19, 2019

Dog’s Call Name  _____________________________________________________

Breed(s) _________________________________________________________________ 

Dog’s NACSW™ #________________

Handler’s Name ________________________________________________________

Handler’s NACSW™ Membership # ____________________________________

Address _______________________________________________________ 

City ________________________________   State _________      Zip________

Phone where you can easily be reached __________________________   

E-mail Address _____________________________________________________

An ORT must be taken and passed at least 14 days before a trial opening date to be eligible for the first draw period.

Please contact your host at least 1 day before the ORT if your female dog will be in season.

All confirmations will be sent via e-mail with attachment within 7 days of receipt of complete registration form and payment.  If you require a confirmation via USPS, you must provide a self-addressed stamped envelope.

I/We hereby assume all risks of, and responsibility for, accidents and/or damage to myself or to my property or to others, resulting from the actions of my dog. I/We expressly agree that Pawsitive Training Zone, Sandra Carbonell, American Legion Post 759, Commander John Rees, and/or NACSW™ or any other person, or persons, of said groups, shall not be held liable personally, or collectively, under any circumstances, for injury, and/or damage to my person, for loss or injury to my property, whether due to uncontrolled dogs or negligence of any member of said groups, or any other cause, or causes.

Signed: ________________________________________________________   Date: ______________________