The 3rd Annual Bulldog Derby: "Festival of Families" Bulldog Derby Registration Form
(Bulldogs must be between 5 months old and 6 years old at time of the Bulldog Derby event to register)
Participant Information
Owner/Handler #1
*
First Name
Last Name
INSTAGRAM Handle
*
(preferably your bulldog's instagram account)
Owner/Handler #2:
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Person
*
First Name
Last Name
Emergency Person Phone Number
*
-
Area Code
Phone Number
Relationship to Emergency Contact Person
*
Bulldog's Full Name
*
First Name
Last Name
Division
English Buldog
French Bulldog
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
Please Select
M
F
Please upload most recent picture of you bulldog (if possible)
*
Browse Files
Cancel
of
Please upload copy of vaccination/shots record(s)
Browse Files
Please bring copy of vaccination record with you to the event
Cancel
of
All contestants must submit a note/letter from Veterinarian clearing your bulldog to participate this activity (running 25-30 yards, one way from one owner at one end to the other owner at the opposite side, and possibly twice) LAST DAY TO SUBMIT PAPERWORK - 03/25/2022 (please submit to thebulldogrepublic@gmail.com)
non-refundable*
Bulldog Derby Race Registration Fee. For Bulldogs over 1 year old = $50.00. For puppies under 1 = $25.00 (due immediately) PAID VIA PAYPAL (thebulldogrepublic@gmail.com)
non-refundable*
Terms/ Waiver/ Release
Please select below:
*
I will follow the rules and regulations of the race event. please see full rules on our website bulldogderby.com
I acknowledge that this race requires physical activity and there are possible risks and danger.I understand these are not for sport or serious races,and that I am not required or mandated to make or force my bulldog to run or participate.
I release the race event organizers or it's venue, partners, sponsors, vendors, or staff for any and all responsibility in case of any and all accidents, illnesses, or injuries. Should a situation arise, please notify BD personnel immediately.
I allow taking my photos or the procedure images that can be used for the event portfolio or advertising.
I confirm that all information in this registration form is accurate and true.
Participant's Signature
*
Date Signed
-
Month
-
Day
Year
Date
Parent/Guardian Signature (If below 18 years old)
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: