Trial Entry Form

Dog Information:

Dogs Registered NameCall Name

Titles:

(e.g. BH, IGP1, FH1)

Breed

Date of Birth

Tattoo NumberMicrochip Number

Scorebook NumberRegistration Number (AKC/FCI/SV)

Select All That Apply

MaleFemaleFemale In Season (Yes)H.O.T.

Does the handler need to take the BH written test?

YesNo

Please indicate the title you are applying for:

For example BH, IGP1, FH1

Name

First NameLast Name

Owner's USCA or AWDF Member NumberExpiration Date

Club Affiliation

Owner's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Name

First NameLast Name

Handler's USCA or AWDF Member NumberExpiration Date

Club Affiliation

Handler's Address (if different than Owner)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Total for all titles sought (will auto-calculate)

This is the total dollar amount for the titles selected. If you are a non-USCA member, please also select the box for the $30 dollar required fee. All fee's are non-refundable as of the entry deadline.

All entries must present a copy of a current membership card for either USCA, an AWDF member club or a WUSV member organization. Please include a copy of a current membership card with your entry form.

Please upload a copy of your current membership card

I hereby acknowledge that I have voluntarily applied to participate in activities sponsored by Rocky Mountain Working Dogs (hereby referred to as RMWD or as the “CLUB”). Being held on the property of Janelle Schrag and Lauren Anema located at 30200 County Road 5, Elizabeth, Colorado 80107 (hereinafter referred to as the “SCHRAG TRAINING FACILITY”), at the property of Ken and Laurie Stupak located at 32800 East 137th Way in Brighton, Colorado (hereinafter referred to as the “STUPAK TRAINING FACILITY”) as well as at Majestic Turf Farms, LLC located at 1283 County Road 38 in Berthoud, Colorado, Epic Estates at Brighton, LLC located at 30101 East 152nd Avenue in Brighton, Colorado and Graff Theil Farms LLC located at 09803 N. I-76 Frontage Road in Fort Morgan, Colorado (hereinafter referred to as “TRACKING GROUNDS”). TRACKING GROUNDS are located on private property that RMWD has negotiated specific authorization to utilize. Trespassers, other than RMWD, may be prosecuted at the discretion of ownership.

I am aware that these activities may involve risk of bodily injury, death, or property damage and I am voluntarily participating with knowledge of the inherent risks. I expressly assume the risk of these dangers, including, but not limited to, slips/trips, falls, dogs, automobile accidents and/or injury from equipment while at THE SCHRAG TRAINING FACILITY, THE STUPAK TRAINING FACILITY AND/OR TRACKING GROUNDS. As lawful consideration for being permitted by CLUB to engage in these activities at THE SCHRAG TRAINING FACILITY, THE STUPAK TRAINING FACILITY AND TRACKING GROUNDS, I hereby release, waive, discharge, and relinquish any action or causes of action for personal injury, property damage, or wrongful death, against Janelle Schrag and Lauren Anema, Ken and Laurie Stupak, the CLUB, THE SCHRAG TRAINING FACILITY, THE STUPAK TRAINING FACILITY AND/OR TRACKING GROUNDS, and his/her/their/its heirs, executors, administrators, successors and assigns, which may hereafter arise from the activities sponsored by the CLUB or any pursuit incidental thereto.

I hereby agree that under no circumstances shall I prosecute or present any claim against Janelle Schrag and Lauren Anema, Ken and Laurie Stupak, the CLUB, THE SCHRAG TRAINING FACILITY, THE STUPAK TRAINING FACILITY AND/OR TRACKING GROUNDS for any causes of action for personal injury, property damage, or wrongful death, whether the same shall arise by negligence or unintentional conduct of anyone participating in the activities sponsored by the CLUB or any pursuit incidental thereto. This Agreement shall bind the members of my family and my spouse, heirs, assigns, and personal representatives, and shall be deemed as a RELEASE, WAIVER, AND DISCHARGE OF LIABILITY, AND COVENANT NOT TO SUE Ken and/or Laurie Stupak, the CLUB, THE SCHRAG TRAINING FACILITY, THE STUPAK TRAINING FACILITY AND/OR TRACKING GROUNDS. This agreement does not restrict my rights in regard to actions against the CLUB.

I understand and agree that I shall be personally responsible for my own safety in participating in the activities sponsored by the CLUB and assume all risks and accept full and complete responsibility for any and all damages and personal injury of any kind, including death.

I HEREBY AGREE TO INDEMNIFY, SAVE, AND HOLD HARMLESS Janelle Schrag and Lauren Anema, Ken and Laurie Stupak, the CLUB, THE SCHRAG TRAINING FACILITY, THE STUPAK TRAINING FACILITY AND TRACKING GROUNDS, AND HIS/HER/THEIR/ITS HEIRS, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNS FROM ANY LOSS, LIABILITY, DAMAGE, OR COST, INCLUDING ATTORNEYS FEES, WHICH I MAY INCUR AS A RESULT OF INJURY, DEATH, OR PROPERTY DAMAGE, OR FROM ANY SUIT FROM SUCH PERSONAL INJURY, DEATH, AND/OR PROPERTY DAMAGE.

If any part of this agreement is determined to be invalid by a Court of law, it is agreed that the balance of the agreement shall continue in full force and effect.

I, THE UNDERSIGNED, HAVE READ AND VOLUNTARILY SIGNED THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT AND FURTHER AFFIRM THAT NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.

I, THE UNDERSIGNED, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT.

Name

First NameLast Name

Date

Signature

Trial Entry Form

Owner's Information

Handler's Information (if different than Owner)

Title(s) Sought

Release, Waiver of Liability, and Indemnity Agreement: