Country K9 2026 Membership & Liability Form

2026 COUNTRY K9 CLUB LTD MEMBERSHIP APPLICATION / RENEWAL
LIABILITY WAIVER
PLEASE PRINT CLEARLY and COMPLETE BOTH SIDES
If renewing please write any changes below or NO changes
NAME(S):
STREET:
CITY:
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHONE:
E-MAIL:
example@example.com
* Please include a paragraph on the reverse side to introduce yourself, family and dogs to the Club's membership. This information may be included in our newsletter/membership list.
What Dog activities are you involved in? What activities are you interested in trying with your dogs? Please add additional activities.
AgilityObedienceRallyNose workFieldConformation/BreedOther
Dogs name
Breed
Dogs name
Breed
Dogs name
Breed
Single Membership - $50 Junior Membership (Under 18) - No Fee
Family Membership (With Single Membership Benefits) - $50
$
Total Remitted- VENMO add $2 fee OR CHECKS Payable to: Country K9 Club LTD LEFT IN BUILDING BOX PROVIDED OR MAILED TO CAROL WYATT COUNTRY K9 CLUB LTD 513 DOTTERS CORNER RD KUNKLETOWN PA 18058 NO CASH PLEASE
Renewal dues are payable by January 31 (Fiscal Year = Jan. 1 thru Dec. 31).
I/We authorize Country K9 Club LTD to notify me of meetings, training, Club events and Club business via electronic mail/social media.
I/we hereby give permission to Country K9 Club LTD to use my/our name(s) and to reproduce my/our photograph(s) in any way the Club deems appropriate. This may include, but is not limited to, use in photo albums, display boards, websites, social media, news media and other publications. This release further grants permission for publication of name and reproduction of photograph(s) by third parties in their

promotion of Club informational programs, activities and in recognition of Club/
Member achievements.
THE APPLICANT(S) AGREE(S), UPON ADMISSION TO MEMBERSHIP, TOABIDE BY THE CONSTITUTION AND BYLAWS OF THIS CLUB
Signature of Applicant:

Clear
Date

MonthDayYear
Date
Signature of Additional Member:

Clear
Date

MonthDayYear
Date
For Treasurer's Use Only: Date Dues Paid
Check number
Rev. 12-8-23
Country K9 Club LTD and (WELD LLC)Waiver of Liability and Indemnification for Training/Club Activities 2024
CONDITIONS FOR ACCESS / INDEMNIFICATION AND WAIVER
1. I understand and confirm that I have been granted access to the property of
Country K9 Club LTD and WELD LLC for Obedience, Agility, Rally, and/or
Breed Handling Classes, and/or Rented Ring/Field Time, Water Training, Nose
Work, Other Training and/or Special Events.
2. I further confirm that my right to enter the property of Country K9 Club LTD and
WELD LLC may be terminated by Country K9 Club LTD or WELD LLC (or any
of their respective owners, directors, officers, agents or employees) at any time
for any reason or for no reason whatsoever.
3. I hereby agree to indemnify Country K9 Club LTD and WELD LLC and to
hold Country K9 Club LTD and WELD LLC and their respective owners,
directors, officers, employees and agents harmless from and against any
claims made against either entity or ay of such listed individuals for any
losses or damages suffered by any entity, individual or animal as a result
of actions by me or my dog on the property of Country K9 Club LTD or
WELD LLC.
4. I expressly warrant and agree that I will not hold Country K9 Club LTD or
WELD LLC or any of their respective owners, directors, officers, employees or
agents liable for any injuries that occur on the property of Country K9 Club LTD
or WELD LLC or otherwise, either to myself or my dog, except with respect to
any such party to the extent caused by the gross negligence or willful
misconduct of such party.
I agree to all of the above:
Signature:

Clear
Print Name:
Date:

MonthDayYear
Date
Email us if you have any questions at: CountryK9Club@gmail.com

Rev. 1/2026
Should be Empty:

2026 COUNTRY K9 CLUB LTD MEMBERSHIP APPLICATION / RENEWAL

LIABILITY WAIVER

THE APPLICANT(S) AGREE(S), UPON ADMISSION TO MEMBERSHIP, TOABIDE BY THE CONSTITUTION AND BYLAWS OF THIS CLUB

Country K9 Club LTD and (WELD LLC)Waiver of Liability and Indemnification for Training/Club Activities 2024

CONDITIONS FOR ACCESS / INDEMNIFICATION AND WAIVER