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RIP CURL WEIGHT PULLERS

A United Kennel Club, Inc. Affiliate

2006 Membership Application

Name __________________________________________Telephone___________________________

Mailing Address______________________________________________________________________

City_______________________________________________State_______Zip___________________

Email_______________________________________________________________________________

MEMBERSHIP & RENEWAL

Annual Membership is from January 1 - December 31

Individual Membership ($20/year) Family Membership - same household ($30/yr.)

Jr. Membership - under 18 yrs. ($10/yr) Adult Sponsor__________________________________

Jr.ís Name_______________________________________________________________Age________

Adult Sponsorís Signature_______________________________________ Date__________________

DOG INFORMATION

Name___________________________________________Breed_________________________________

Name___________________________________________Breed_________________________________

Name___________________________________________Breed_________________________________

Please share some information about your areas of interest in dog sports and any past experience

The undersigned hereby agrees to adhere to the policies of the United Kennel Club, Inc. and the

Constitution and By-Laws of Rip Curl Weight Pullers as well as to promote and encourage camaraderie

and good sportsmanship among dog sports competitors and to promote responsible ownership of all

dogs and responsible breeding of purebred dogs.

Signature_______________________________________Date_________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Mail with payment to:

Karyn Dawes, P.O. Box 1719, San Marcos, CA 92079

Payment is due by December 31

 

Please print out and sign waiver.

WAIVER, ASSUMPTION OF RISK AND AGREEMENT TO HOLD HARMLESS

I understand that attendance at a dog training session, instructional or self-practice use of a training

field and equipment, or sanctioned competition is not without risk to myself, members of my

family or guests who may attend, or my dog, because some of the dogs to which I may be exposed,

as well as my own dog, may be difficult to control and may be the cause of injury even when handled

with the greatest amount of care. I also acknowledge that there is an inherent risk in utilizing

any type of training equipment, especially that designed and used for the sport of agility or weight

pull.

In consideration of and as inducement to the acceptance of my utilization of your training facility, I

hereby waive and release Karyn M. Dawes d.b.a. Dogpatch Dogsports Center, its employees, officers,

members and agents, including, but not limited to, San Diego Dog Fanciers and Rip Curl

Weight Pullers including all officers and members, from any and all liability of any nature for injury

or damage which I, my family and guests, or my dog may suffer, including specifically, but without

limitation, any injury or damage resulting from the action of any dog, contact with or use of, by

either my dog, myself or my guests, any equipment, property fixtures or the training field and surrounding

area thereto and I expressly assume the risk of such damage or injury while attending

any training session or any other function of Dogpatch Dogsports Center, or while on the training

grounds or the surrounding area thereto.

I also agree to indemnify and to hold harmless, Karyn M. Dawes, Dogpatch Dogsports Center, its

employees, officers, members and agents including, but not limited to, San Diego Dog Fanciers and

Rip Curl Weight Pullers including all officers and members, from any and all claims, or claims by

any member of my family or any other person accompanying me to any training session, the training

grounds, a sanctioned event, or function of Dogpatch Dogsports Center, or while on the

grounds or the surrounding area thereto, as a result of any action by any dog, including my own,

any equipment, property fixtures or the training field and surrounding area thereto. I shall personally

assume any and all responsibilities and liabilities for any loss or injury which may be alleged to

have been caused directly or indirectly to any person or thing by the act of my dog or myself while

participating in a Dogpatch Dogsports Center dog training program or while on the training

grounds or the surrounding area thereto.

(My dog in the above statements means any dog in my custody upon approaching the training

grounds or adjacent area.)

I further acknowledge that I have read and understand the rules posted for utilization of Dogpatch

Dogsports Center and all equipment and agree to abide by them.

Name_______________________________________ Telephone_____________________________________

Address_____________________________________________________________________________________

City______________________________________________________State__________Zip________________

Signature_________________________________________________

Parent/Guardian if under 18_________________________________

Date______________________________________________________

Rip Curl Weight Pullers