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.’s Name_______________________________________________________________Age________ Adult Sponsor’s 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
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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
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