EmailMe Form - Qualified Dog Registration Form & Waiver (2024)

1. Information About You

Name *

First Last

Phone *

### - ### - ####

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Information About Your Pet

Dog's Name *

Breed *

Color *

Size/Weight *

Age *

Sex *

Male

Female

Neutered/Spayed *

Yes

No

Has your pet ever been deemed a dangerious/potentially dangerous animal at any time in the past? *

Yes

No

Upload Photo of Dog *

*Photo must be clear of the dog's head and may include the body.

Vaccination Information

Provide EXPIRATION DATE of each vaccination. All vaccinations must be current at time of Faire visit.

Rabies *

MM / DD / YYYY

Distemper *

MM / DD / YYYY

Parvo *

MM / DD / YYYY

Information About Your Veterinarian

Clinic Name *

Vet Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Qualified Dog Waiver (2024)

I am aware that during my visit to the Pennsylvania Renaissance Faire, certain inherent risks are involved, including, but not limited to, negligence on my part or another person’s party. In consideration of this, I hereby declare that my dog has NOT been deemed to be a dangerous or potentially dangerous animal and agree that the Pennsylvania Renaissance Faire, it’s owners, agents, assignees or employees shall be liable to the undersigned, or those claiming through or under the undersigned, for injury, death, personal loss or property damage suffered or caused by my own negligence, or the negligence of someone else. If a bite, scratch or other injury or damage should occur, I agree to (1) report it immediately to a Faire staff or security representative and (2) remain on site with my pet until I have received instructions from the local authorities regarding the required procedure. I have read the Dog Days Decrees. I understand and agree to compliance for my dog and myself. I also certify that the information I have given is correct and current.

I hereby certify to the following facts:
1. I am the owner of the dog attending the Pennsylvania Renaissance Faire.
2. I will be in control of my dog at all times while at the Pennsylvania Renaissance Faire.
3. All of the information I have provided in this Qualified Dog Registration, Waiver Form and photo of my dog is accurate.
4. My dog has not been deemed a dangerous or potentially dangerous animal at any time in the past.
5. My dog has never caused a problem in a crowded public environment.

If my pet should bite a person, bite another pet, cause property damage, and/or be directly or indirectly involved in any incident, I agree to do the following:

1. Report the incident immediately to a Renaissance Faire staff or security member.
2. Remain on site with my pet and available until I have received instructions from the Renaissance Faire staff and/or local authorities regarding the required procedures.

Registration Authorization & Waiver Agreement

I have read and understand the Qualified Dog Registration and Waiver Form. I understand and agree to full compliance for my pet, my guests and myself. I certify that all information I have provided on the Qualified Dog Registration Form is current and correct.

Signature *

Clear

Date Time *

MM / DD / YYYY