The United States Police Canine Association, Inc

Ohio Law enforcEment k9 association

“To improve K-9 use, training and confidence by forming partnerships from multi jurisdictions around the state."

Dear Participant,

Please fill out this packet in its entirety to ensure acceptance into the competition. All packets must be received by the date listed.

You can join OLEKA on site prior to the start of the competition.

If you have any questions please send inquiry to .

Send all packets by their listed deadline to:

OLEKA

“TOP DOG”

Chairman Ed Ripepi

7424 Braewood Dr.

Independence, Ohio 44131

Sincerely,

Gerald Bemis

President

Ohio Law Enforcement K9 Association

Ohio Law enforcEment k9 association

“To improve K-9 use, training and confidence by forming partnerships from multi jurisdictions around the state."

Northeast Ohio

2ND Annual “TOP DOG” Competition

PATROL/NARCOTICS

May 15, 2010

Padua High School

6740 State Road

Parma, Ohio

REGISTRATION FORM

NAME:

DEPARTMENT:

DEPARTMENT ADDRESS:

DEPARTMENT PHONE NUMBER:

DEPARTMENT FAX NUMBER:

E-MAIL ADDRESS:

K-9 NAME:BREED:

NARCOTICS YOUR K-9 IS TRAINED TO DETECT:

MARIJUANA HASHISH COCAINE METH HEROIN

SHIRT SIZE: 3 XL 2 XL XL L M S

APPREHENSION STYLE: BITE AND HOLD BARK AND HOLD

REGISTRATION FEES: $50.00Non-OLEKA Member (Includes 2010 Membership)

$20.00OLEKA Members

Please make checks payable to:OLEKA “TOP DOG”

Attn: Ed Ripepi 7424 Braewood Dr.

Independence, Ohio 44131

DEADLINE IS APRIL 15, 2010

P.O. Box 104 • New Lebanon, Ohio • 45345

Phone: 937-687-1476

Ohio Law enforcEment k9 association

“To improve K-9 use, training and confidence by forming partnerships from multi jurisdictions around the state."

Photo/Liability Release Form

During attendance of this OLEKA K9 Competition staff members will be taking photos for future OLEKA presentations and promotions. All photos and video will contain the utmost professionalism and will project the quality course desired by OLEKA.

By signing this form you are releasing all photos and/or video that are taken during your attendance of the OLEKA certification and further give permission for staff to use that acquired media in manners conducive to the mission of OLEKA and its promotion.

I here by waive and relinquish Ohio Law Enforcement K9 Association (OLEKA), Ohio Law Enforcement K9 Association (OLEKA) Board Members, the City of Parma, Ohio, Padua High School District and all other event organizers from any injury to myself or K9 while participating in this Competition. I also agree to abide by the rules established by the Ohio Law Enforcement K9 Association’s Competition Rules while attending this Competition

My K9 is currently up to date on all required vaccinations. I accept responsibility for any damages caused by my K9, to the property or any other person while attending and participating in this Competition.

Print Name

Signature

Date

Ohio Law Enforcement K9 Association

MEMBERSHIP APPLICATION

Annual Contribution: Regular $30.00 and Associate Members - $30.00 per Year

Today's Date: ______/______/______Date of Birth: _____-_____-_____

Last Name: ______First: ______MI: ______

Home Address: ______

City: ______State: ______Zip: ______

Home Phone Number: (area code) ______-______-______Email ______

Type of membershipRegular Active Associate

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Answer ALL questions.

Are You a Certified Law Enforcement Officer? Yes___ No___

If yes: State Federal Local Fire/Investigator EOD

Do you have Arrest powers?Yes___ No___

Are you and the K9usedbyyour Law Enforcement Employer? Yes___ No___

Police/Law Enforcement Agency Employed by: ______

Work Address:______

City: ______State: ______Zip: ______

Work Phone Number: (area code) ______-______-______Email ______

Position (circle one): Handler, Trainer, Other - describe:Narcotics Explosives Patrol Accelerant S&R

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Associate Member

Indicate type of Associate Out of State Law Enforcement K9 Out of State Law Enforcement non K9

In state Law Enforcement non K9 Emergency Responder

Private for hire K9 handler In State non Law Enforcement non K9

Regular Member signature sponsoring you: ______If you have no sponsor leave blank.

Regular Member - print your name here______

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K9 Information

K-9's Name: ______Date of Birth: _____-_____-_____

Age: ______yrs. ______months Sex: M F

Breed: ______Color(s):______

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NOTE: All personal checks that do not clear will be charged a $30.00 fee in addition to membership fee and any bank fees you may incur.

All applications are subject to background check for authenticity and integrity. By submitting this application you agree that all information is correct and truthful to the best of your knowledge.

(Applicant Signature)

Send Membership form and fees (payable OLEKA) to:

Ohio Law Enforcement K9 Association

P.O. Box 104

New Lebanon, Ohio 45345

P.O. Box 104 • New Lebanon, Ohio • 45345

Phone: 937-687-1476