Participation Agreement PWDCA Water Trial Entry Form Fill out form

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Participation Agreement
PWDCA Water Trial Entry Form
Conditions: These trials are open to pure bred Portuguese Water Dogs. I/we understand that the dogs must be
in good health, proper fitness and condition for the test they are about to enter and must be at least 6 months of
age in order to compete in the water trials. I/we agree to these terms. I/we accept full responsibility for the care of
my dog(s) during the water trial.
Hosted by NUTMEG PWDC, Inc
54 Flint Ridge Rd, Monroe,CT 06468 I/we agree to
Special Rules: The water trial is located within the confines of ____________________________.
become familiar with and adhere to all site rules and regulations including but not limited to the following:
x Dogs must be on leash or confined to a crate at all times except when participating in practice sessions or
when actually being judged.
x If my dog soils the grounds, I am responsible for cleanup and disposal.
x Nothing (dogs, banners, etc.) is to be attached to any tree in the park.
General Rules: The Portuguese Water Dog Club of America, Inc., (hereinafter ““PWDCA””) rules, regulations,
policies and guidelines for water trial participants (hereinafter ““the rules””) are in the cur-rent PWDCA Water Trial
Manual available on the Web site, www.pwdca.org. I/we have received the current Manual and/or have read the
rules via the Web site and I/we agree to obey the rules.
Hold-harmless: I/we agree to hold the PWDCA and the event-giving club, their members, directors, officers,
agents, and judge(s) at this event, the owner and/or lessor of the premises, any provider of services for this event
and any employees or volunteers of any of the aforementioned parties, harm-less from any claim for loss, injury,
or illness which may be alleged to have been caused directly or indirectly to any person, animal or thing by the act
of my dog while in or upon the trial grounds or while entering or leaving same, and I/we further agree to hold the
aforementioned parties harmless from any claim for loss, disappearance or theft of, or damage injury or illness to,
my dog, whether such loss, disappearance, theft, damage, injury or illness is caused or alleged to be caused by
the negligence of the club or any other parties aforementioned, by the negligence of any other person, or by any
other cause or causes.
Indemnification: I/we hereby assume the sole responsibility for and agree to indemnify and save the
aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability
imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at
any time resulting there from, sustained by any person or persons, including myself (ourselves) or on account of
damage to property, arising out of or in consequence of my (our) participation in this water trial, howsoever such
same may have been caused or may be alleged to have been caused by negligence of the aforementioned
parties or any of their employees or agents, or any other persons.
August 20 & 21, 2016
54 Flint Ridge Rd, Monroe, CT 06468
Entry Fees: $40.00 per entry/per day. Entries open Immediately
__and close at the trial
secretary’’s mailbox on July 30, 2016 at 5:00 pm
after which time entries cannot be cancelled
for refund. If using an overnight service, please indicate ““no signature required”” for delivery.
Mail entries to: Marie Forgach, 7 DeMott Ave. Rockville Centre, NY 11570
Will you be joining us for the Saturday evening BBQ? yes:___ # attending:___
Please remember to volunteer on the separate form and submit it with your entry form and check
Junior
Apprentice
Working
Courier
Versatility
Level entered (one level per dog):
Saturday
Sunday
Days entered: ________________
________________
________________
________________
Nutmeg PWDC, Inc
Make checks or money orders payable in U.S. funds to _______________________________________
I enclose $
for entry fees.
Fill out form completely. Use the TAB key to move from field to field.
Prefix Titles
Registered name of dog
Suffix Titles (include PWDCA titles)
Date of Birth
Sex
Call Name
AKC # or Foreign Reg # (list country)
Breeder
Sire
Dam
Owner(s)
Phone
Address
City/State/Zip
Owner(s) Email
Arbitration: Notwithstanding any of the above, in the event that I/we or my dog(s) suffer any damage, injury,
illness, or loss (including the death of the dog(s) arising from the water trial), I/we agree that any claim arising out
of or related to the entry, exhibition or attendance at the event or as to the construction, interpretation and effect of
this agreement shall be settled by arbitration pursuant to the applicable rules of the American Arbitration
the State of Connecticut
Association. I/we agree that any such arbitration will take place in _____________________________within
60
days of the incident giving rise to the claim, or at such other time and place as the parties may agree. I/we agree
to pay a prorated share of the costs of any such arbitration.
Handler
I/we agree that these clubs have the right to refuse this entry or any entry for any cause which they deem to be
sufficient.
I hereby certify I am the actual owner of the dog or duly authorized agent of or handler for the actual owner whose name has been
entered above. I have read, signed, and agree to be bound by the Participation Agreement which is part of this entry form, as well as
stipulations contained in the premium list plus any directive received from any official involved in staging the event. I certify and
represent that the dog entered is over 6 months of age (at the time of this event) and is not a hazard to persons or other dogs.
Owner/Handler’’s initials:
Substitute Steward’’s initials:
Date:
Date:
Entry is not valid unless accompanied by WKLV signed and dated Participation Agreement.
Entry is not valid unless signed, dated, and submitted with correct fees by the closing date.
Phone
Address
City/State/Zip
Handler’’s Email
Substitute Steward
Phone
Signature of owner/handler*
Date
Signature of substitute steward*
Date
*If the handler and/or substitute steward named herein is under 18 years of age (must be at least 9 or older), this entry form
must be signed and acknowledged by his/her legal guardian.