Date:    

 Name:   

  Address:

  City:      State:    Zip Code:

  Home Phone:   Evening Phone:   Cell:  

  Email Address:  

  DOB:                       Social Security No.

  Are you over the age of 18? Click Yes No If No, you must also have the application signed by your parent or guardian.

 Emergency Contact

  Name:

  Address: City: Zip:

  Home Phone: Other Phone:

  Are you allergic to any medications, insects etc.  Click Yes No If yes, please list what you are allergic too.

  Are there any medical conditions that would limit you from joining the search team? Click Yes No If yes please list.

  Current Medical Doctor: Phone:

  Will your employer allow you to be contacted for call outs? Click Yes No

  It is understood that being an active or associate member of O.R.D.A. K-9 can involve a great deal of time and

  out of pocket expense. (Training, travel & equipment)  Also each active and associate member is charged a    

  $25.00 a year membership fee due the 1st of January of the new year.  Please initial if you understand and agree.

  Do you currently have any training or certifications in Search & Rescue, EMS, Law Enforcement etc. Click Yes No

  If yes please list your training or certifications.     A photo copy will be required upon acceptance to the team.

   Do you currently own a dog that you think would be suited for SAR training?      Click Yes No If yes please list below.

   Dogs Name: Breed: Age:  

   Gender: Male Female Veterinarian Name: Phone:

   Is your dog up to date on all his or her vaccinations?  Click Yes No (You will be required to provide copies)

   Has your dog been through any type of training prior to this application? (Obedience, Shutzhund)   Click Yes No  

   If yes, please list below. 

   Do you have reliable transportation to attend trainings, events and callouts? Click Yes No As an active or associate 

   member you are required to attend (50) fifty percent of all trainings, events and callouts.   

   Have you ever been convicted of any charge, other than a traffic citations? Click Yes No   If yes please list below.

   (A conviction does not necessarily disqualify an applicant from joining the search team)

    By signing below, I state that I am aware that O.R.D.A. K-9 Search Team is a volunteer Emergency Response Unit 

    and that as a member I may be called upon during times of sever weather, disaster or other such hardship.    

    Should I have any health or other conditions that may limit my abilities, it is my responsibility to inform the

    officers of the search team of such to avoid increased risk.  Also by signing below I understand that any injury

    to myself, my K9 or any others, I will not hold O.R.D.A. K-9 or it's officers/agents responsible.  I also understand 

    that by signing below I am allowing O.R.D.A. K-9 to investigate and or research any of the information I have 

    given in this application.

    (Please type your legal name)

    Signature of Applicant 

    (Please type your legal name)

    Parent or Guardian (If under 18 years of age)

    Notice:  This is a preliminary online application, upon acceptance to the search team you will be required to

                 fill out a hard copy of this application.

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