Out Back Trial Entry – Jumpers Jubilee – June 21, 2025 – Late Entry

AAC Sanctioned Agility Trial Registration – Jumpers Jubilee

Saturday, June 21, 2025 – Limited Entry
$23/run Late Entry rate in effect – $11/FEO run
All prices now include HST.

Trial full, waiting list only –
Do not send payment until confirmed.
Handler/Owner Information
Name*

First NameLast Name
Date*

MonthDayYear
Date
Email*
example@example.com
YesNo
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Emergency Contact Name
  
  First NameLast Name
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- YesNo
- YesNo

- Payment
  
  Your required payment is calculated for you, please review the information and follow the payment instructions. Remember that payment is required at time of entry to secure your entry (unless trial is waitlisted, in which case please await confirmation before making payment).
- Grand Total ($) to be Paid
  All dogs, Events + FEO Events entered, with event fee based entry date - Early Bird, Regular, or After Closing Date
- e-transfer to KandyDumm@hotmail.com – if password required, use "outback"cheque payable to Kandy Dumm, mailed to Kandy Dumm, 5809 Marine Station Rd, Iroquois, ON K0E 1K0Other (please explain in comment field below)
- Entries may be allowed after closing date if the trial is not full. Please contact
  outbacktrials@gmail.com to request late entry.
- Comment:
  Anything you would like Outback to know about your entry or payment
- Volunteering:
  
  By submitting this trial entry, competitors acknowledge that they will agree to perform volunteer duties at the trial as necessary.
- Covid Questionaire
- COVID-19 Screening Questions
  
  (1) Are you currently experiencing any of these symptoms? Fever and/or chills; cough or barking cough (croup); shortness of breath; sore throat; difficulty swallowing; runny or stuffy/congested nose; decrease or loss of taste or smell; pink eye; headache; digestive issues like nausea/vomiting, diarrhea, stomach pain; muscle aches; extreme tiredness; or falling down.
  (2) Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
  (3) In the last 14 days, have you been identified as a "close contact" of someone who currently has COVID-19?
  (4) Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying home)?
  (5) In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?
  If in the last 14 days, you or anyone you live with travelled outside of Canada, please see the Trials Secretary when you arrive at the trial.
- By entering my name here, I agree that I will not attend the Trial if on the day of the Trial, I answer "yes" to any of the above questions.*
  
  First NameLast Name
- Agility Association of Canada ("AAC")
  
  Participation Waiver and Release
- AAC Participant Waiver & Release
  
  In consideration of the acceptance of this entry by AAC and Outback Agility and Dog Sports (the “Organizing Club”) and the opportunity to have the Dog participate, compete in and/or be judged at this event or trial (the “Event”), I, the undersigned, agree as follows:
  I certify that I am the actual owner of the Dog, or that I am the duly authorized agent of the actual owner of the Dog and that the Dog is not a hazard to persons, property or other dogs.
  I agree that AAC or the Organizing Club for the Event may refuse my entry for any reason that it deems to be su!cient.
  I understand and acknowledge that participation in the Event carries certain risks, including, but not limited to injuries (including serious injuries and death) to myself, the Dog, another dog under my control or persons attending as my guests (my “Related Parties”), damage to property and other losses. I waive any and all claims that I have or may have in the future against, and release from all liability and agree not to sue AAC, the Organizing Club or any of the directors, executives, committees, representatives, employees, volunteers or agents of either AAC or the Organizing Club (the “Personnel”) for any injury, death, property damage or other loss that I or my Related Parties sustain due to any cause whatsoever, including negligence, breach of contract, breach of duty, statutory or otherwise, or mistakes or errors of judgment of any kind.
  I assume full responsibility for the conduct of myself and my Related Parties during the entirety of the Event. I agree to indemnify and save harmless AAC, the Organizing Club and the Personnel from and against any and all claims that may be made against them or costs, fees, expenses or liability (including, without limitation, lawyers’ fees on a solicitor and own client basis) incurred by AAC, the Organizing Club or the Personnel that may arise due to:
  (a) any act or omission of myself, my Related Parties or any party for whom I am liable at law; or
  (b) aggressive behaviour by the Dog or any other dog under my control. I have read, and do understand the rules of competition and the additional rules (if any) appearing in the trial schedule for the Event, as well as the policies of AAC pertaining to discipline (collectively, the “Rules”). I agree to abide by the Rules and to conduct myself and the Dog in accordance with the Rules. I understand that myself and/or the Dog may be subject to disciplinary procedures or sanctions for breach of the Rules and agree to respect and be bound by any disciplinary decision made by AAC.
  I understand that AAC and/or the Organizing Club may, in the course of administering the Event or conducting its activities generally, collect, use or disclose my personal information and that any personal information collected, used or disclosed by AAC and/or the Organizing Club will be treated in accordance with AAC policy and applicable privacy and personal information laws. I hereby consent to the collection, use and disclosure by AAC and/or the Organizing Club of my personal information.
  Media Release & Rights of Privacy Waiver
  I Hereby Grant to AAC and its affiliated companies, representatives, agents and assigns, all rights and permission to use or appropriate his/her and their dog’s name, biography, likeness, photograph, voice, performing persona, or other indicia of identity for broadcast, telecast, cablecast, transmission or distribution in any format or media known now or in the future.
  Waiver of Rights to Privacy, Publicity & Personality
  Further, I hereby release Agility Association of Canada Inc, and its affiliates, representatives, agents and assigns from any claim or cause of action for invasion of the rights of privacy, right of publicity, right of personality, or any similar rights.
  I have been given the opportunity to read and understand the terms of this Agreement before signing it, and have in fact done so. I understand that by signing this Agreement, I am restricting my legal rights and I sign this Agreement voluntarily and of my own free will.
- Waiver & Release for entrant with name:*
  
  First NameLast Name
- Waiver & Release covers dog #1 with call name:*
  Dog #1 name and ID as entered above
- AAC ID# dog #1:*
  Note: enter 00000 if number is pending
- Waiver & Release covers dog #2 with call name:*
  Dog #2 name and ID as entered above
- AAC ID# dog #2:*
  Note: enter 00000 if number is pending
- Waiver & Release covers dog #3 with call name:*
  Dog #3 name and ID as entered above
- AAC ID# dog #3:*
  Note: enter 00000 if number is pending
- By filling in my name here I am signing the above Participation Waiver and Release. I acknowledge that I have read and agree to the terms of this Agreement.*
  
  First NameLast Name
- Waiver & Release Signed on Date*
  
  MonthDayYear
  Today's Date
- Click on the "Submit" button below to submit your entry. An email copy of your entry
  form will be sent to you, and to the Trials Secretary. You will receive confirmation of
  your entry.
  
  Handlers under 18 must have parent/guardian sign this form.
- Should be Empty:

AAC Sanctioned Agility Trial Registration – Jumpers Jubilee

Handler/Owner Information

Dog #1 - Information & Event Selection

Dog #2 - Information & Event Selection

Dog #3 - Information & Event Selection

Payment

Covid Questionaire

Agility Association of Canada ("AAC")