SPACE IS LIMITED.REGISTER NOW!

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1 MUNICIPAL LAW ENFORCEMENT OFFICERS ASSOCIATION CANINE SELF DEFENCE SPACE IS LIMITED.REGISTER W! ADMISSION INFORMATION: This workshop is open ONLY to individuals who are actively employed by a municipality, eligible to hold a student membership, or have an employment history in a related field eg. provincial ministry, security, auxiliary police, retired police officer. The MLEOA reserves the right to decline registration of any individual who does not meet this criteria. The Municipal Law Enforcement Officers Association is pleased to announce the release of the new CANINE SELF DEFENCE WORKSHOP. Regardless of what by-law you are enforcing, as a Municipal Law Enforcement Officer, you may be subject to some situations involving aggressive dogs while performing your job. It is very important for you, as an officer, to understand that you are not required to get hurt during the performance of your duties. The skills you will learn in this workshop will better equip you to deal with situations where you may encounter an aggressive dog during the performance of your duties. Upon completion of this module you will be able to: -recognize and understand canine body language -understand canine behaviour traits -learn methods to de-escalate an aggressive dog -recognize the signs of an impending attack -understand standard use of force as it pertains to dogs -prepare precise and accurate incident notes; and, -learn self defence skills that are simple yet effective. (There is a physical component which students should be prepared to participate in. A liability waiver is required from all students enrolling) ******************************************************************************************** DATE: Monday, May 15, 2017 LOCATION: TIME: CITY OF LONDON AJT Bathurst training Centre (classroom B & C) 663 Bathurst Street, London Session 1 - Registration 8:00 8:30 a.m. Workshop 8:30 a.m. 12:00 noon MAXIMUM 18 STUDENTS - SPACES ARE AVAILABLE on a first come first served basis Session 2 - Registration 12:30 p.m. 1:00 p.m. Workshop 1:00 p.m. 4:30 p.m. MAXIMUM 18 STUDENTS - SPACES ARE AVAILABLE on a first come first served basis

2 APPLICANT INFORMATION (PLEASE PRINT) Note: Attached Waivers (2) MUST BE SIGNED by each student PREFERRED SESSION PARTICIPANT S NAME (as you wish it to appear on your certificate) MUNICIPALITY/EMPLOYER MAILING ADDRESS SESSION 1 (A.M.) SESSION 2 (P.M.) PHONE FAX CURRENT MLEOA MEMBER If No, specify: Student. Current Program: Related employment history. Specify: PREFERRED SESSION PARTICIPANT S NAME (as you wish it to appear on your certificate) MUNICIPALITY/EMPLOYER MAILING ADDRESS SESSION 1 (A.M.) SESSION 2 (P.M.) PHONE CURRENT MLEOA MEMBER If No, specify: FAX Student. Current Program: Related employment history. Specify:

3 REGISTRATION FEE CANINE SELF DEFENCE MEMBER (per person) ½ day $ N-MEMBER (per person) ½ day $ All registration fees incl. 13% H.S.T. METHOD OF PAYMENT CHEQUE Please make cheques payable to: Municipal Law Enforcement Officers Association (Ontario) Inc. reference CANINE SELF DEFENCE CREDIT CARD Mastercard Visa Name on Card address of Cardholder Credit Card # Expiry Date Signature of Cardholder For Office Use: ELIGIBILITY CONFIRMED Reviewed by: Please forward completed applications together with payment to: By mail to: By FAX to: By to: Brenda Russell, MLEOA c/o Box 6, 1107 East Grandview Lake Road Baysville, ON P0B 1A0 CONFIDENTIAL Brenda Russell, MLEOA trac2284@gmail.com REGISTRATION AND CANCELLATION POLICY: 1. All registration forms must be accompanied by support documentation, SIGNED waiver and payment in full to activate the registration process. Registration forms not accompanied by payment will be considered INCOMPLETE and held pending receipt of payment. REGISTRATION FEES ARE N-REFUNDABLE (effective March 24, 2014). 2. Completed registrations will be processed on a FIRST COME FIRST SERVED basis and based on course availability. 3. The Association reserves the right to decline any incomplete registration form or the registration of an ineligible applicant. 4. The Association reserves the right to cancel any workshop at its discretion.

4 MUNICIPAL LAW ENFORCEMENT OFFICERS ASSOCIATION (ONTARIO) INC. Liability Waiver Form To the best of my knowledge, I am in good physical condition and fully able to participate in the Canine Self Defence course (the Course ). I am fully aware of the potential risks and hazards connected with the participation in the Courses, including but not limited to: Injury from physical contact such as grappling, striking, being struck, and use of equipment during self-defense drills and demonstrations with instructors, assistants, or other trainees; Property damage or loss due to contact with instructors, assistants, or other individuals or trainees. I hereby elect to participate voluntarily in the Courses knowing that the associated physical activity may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS INCLUDING PERSONAL INJURY, DEATH, AND PROPERTY DAMAGE that may be sustained by me as a result of participation in the Courses. I further certify that I am at least 18 years of age. I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT T TO SUE The Municipal Law Enforcement Officers Association (Ontario) Inc. and/or Julie Ott (Speyer) operating as Canine Foundations, their respective officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, that may be sustained by me, or to any property belonging to me, while participating in the Courses, while on or upon the premises where the course is being conducted, or by the application or use of the training by me any time thereafter. It is my expressed intent that this Waiver of Liability Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, executors, assigns and personal representatives, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, and CONVENTION T TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability Agreement shall be constructed in accordance with the laws of the Province of Ontario, and the laws of Canada as applicable therein. In signing this release, I acknowledge and represent that I have read the foregoing Waiver of Waiver of Liability, understand it and am signing it voluntarily on my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I execute this release for full, adequate and complete consideration fully intending to be bound by the same. Medical Conditions Attendee s Printed Name & Phone # Signature Date Emergency Contact & Phone Number

5 Municipal Law Enforcement Officers Association CONSENT AND RELEASE I hereby grant permission to the Municipal Law Enforcement Officers Association of Ontario Inc. and their partners (hereinafter collectively referred to as the MLEOA ) to the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of the photographed and/or filmed images of me for use in connection with the activities of the MLEOA or for promoting, publicizing or explaining the MLEOA or its activities and/or programs. These images may appear in any of the wide variety of formats and media now available to the MLEOA and that may be available in the future, including but not limited to print, broadcast, electronic, digital and social media. Unless otherwise expressly agreed to in writing in advance, no royalties, fees or other form of payment or compensation whatsoever will be provided to me for or in connection with any current or future use of photographed and/or filmed images of me. The MLEOA and its representatives may, but are not obligated to, in their discretion, disclose my name in connection with their use of the photographed and/or filmed images of me. I hereby waive my rights and release and agree to hold harmless the MLEOA and all of its representatives from any and all claims of any nature whatsoever which I may now or in the future have against any or all of them by reason of any fact or matter in any way relating to or arising from their ownership or use of photographed and/or filmed images of me. I hereby waive any right that I may have to approve, at any time, the manner of use of the photographed and/or filmed images of me. Signature: Date: Name (Printed): Witness Signature: Date: Name of Witness (Printed):