Mo-Kan Pet Partners Evaluation Registration

Sponsored by Mo-Kan Pet Partners Association (Mo-Kan affiliate number is 40177). Evaluation Fee: $10.00 per animal per evaluation. Appointments must be made for evaluations. Appointments will be scheduled in the order received. Space is limited so completed paperwork and check will reserve your spot.

If you prefer to print this form and mail a check, click here.

Complete a separate form for each animal.

What to complete to schedule your appointment:

This form completed (online with online payment or printed with a check for payment)
Handler’s Questionnaire filled out, click here to download the form. Fill out the form and save it as a document to your desktop then attach it within this registration form.
A copy of Handler Course Completion Certificate (new teams only)
Proof of current Rabies Vaccination Certificate

Important information: Pets must be at least one year old. Pets must be living at owner’s household/home for a minimum of six months. Animals must be clean and well groomed. Per Pet Partners regulations, you will not be evaluated if you do not bring the required items listed on the previous page or are late for your scheduled evaluation time.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Animal's Name:*
Animal's Species:*
Breed:*
Animal's Date of Birth*
Spayed/Neutered?*
- Yes
- No
How long have you had your animal?*
Requested Evaluation Date:*
I am a:*
- Renewing Team
- New Animal
- New Handler (Took Instructor Led Class)
- New Handler (Took Online Class)
Date of class or on-line course?*
Existing Teams: Registration Expiration Date
Existing Teams: Pet Partner Number
Please upload a photo of your current rabies certificate.*
Accepted file types: jpg, png, pdf, Max. file size: 256 MB.
Please upload a photo of your completed handler course certificate.
Accepted file types: jpg, png, pdf, Max. file size: 256 MB.
Please upload your completed handler's questionnaire.*
Drop files here or
Max. file size: 256 MB.
Evaluation Registration Fee
Price:
I indemnify and hold Pet Partners, Mo-Kan Pet Partners, and the evaluation facility harmless from and against all claims, losses, liabilities, and damages to persons or property, governmental charges of fines and attorneys fees arising out of the acts or omissions of Pet Partners Animal Evaluation, including but not limited to interactions with evaluators, volunteers, attendees, or animals, screening or demonstrations involving my pet, or transportation of my pet to or from the evaluation site or within the evaluation site.
Photo/Video Release I, the undersigned, do hereby consent of my own free will, without coercion or inducement of any kind, to grant to MO-KAN Pet Partners to reproduce, copyright, publish, circulate or otherwise use photographic reproductions or likenesses or videotape segments of me and or my name. This authorization and release covers the use of said material in any published form and any medium of advertising, publicity or trade in any part of the world for ten years from the date of this release. Furthermore, I for myself, my heirs, executors, or administers, sell assign and transfer to the organization and its successors all my rights, title and interest in and to all reproductions taken of me by representatives of the organization. This agreement fully represents all terms and considerations and no other inducements, statements or promises have been made to me. I fully understand to no monetary payment will be made to me for such uses as described above.
Signature
Total
$0.00
Thank you for completing the Pet Partner evaluation form! Upon clicking the "Submit" button below, you will be redirected over to Paypal.com to complete your purchase details. We will receive your information once you submit this form and we will receive a notification from Paypal when you complete your payment. Thank you so much and we look forward to seeing you soon!

Mo-Kan Pet Partners Evaluation Registration

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