TOP DOG ENTRY FORMACCIDENT WAIVER & RELEASE OF LIABILITY FORM

TOP DOG ENTRY FORMACCIDENT WAIVER & RELEASE OF LIABILITY FORM
Sponsoring ADBA Club Name:
Date of Activity/Event:
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.
I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event. I agree to cooperate with hosting club officials/judge if an incident occurs so a report may be completed and submitted to the ADBA for further investigation.
In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my dog(s), my executors, administrators, heirs, next of kin, successors, and assigns as follows:
(A) I WAIVE, RELEASE, AND DISCHARGE from all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property injury/damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS:
The American Dog Breeders Association Inc.; Sponsoring ADBA Club (as named above) and/or their directors, officers, employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;
(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise.
I acknowledge that the above entities listed above, and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of the sanctioning, sponsoring and/or hosting identity.
I acknowledge that this activity or event may involve a test of a dog's and/or person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, judges, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to participants but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event.
I understand that at this event or related activities I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.
The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
Initial Here
Pg. 1

I CERTIFY THAT I AM 18 YEARS OLD AND HAVE READ THIS DOCUMENT IN ITS ENTIRETY. I FULLY UNDERSTAND ITS CONTENT AND AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
Print Name

First NameLast Name
Sign Here
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I a minor child participating in this event?
PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old)
The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward's participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
Participant's Name

First NameLast Name
Age
Parent or Guardian Name (print)

First NameLast Name
Parent/Guardian signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Print Dog's Registered Name:
Print ADBA/LPP Reg. Number:
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
(Dog must be at least 9 months old to date of birth to compete)
Check Box(es): Top Dog Sanctioned Event – $50/dog/entry
Should be Empty:

TOP DOG ENTRY FORMACCIDENT WAIVER & RELEASE OF LIABILITY FORM

PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old)