JCAC Membership Form

MEMBERSHIP FEES:

Single $20
Family $25
Lifetime $0

NOTE:

Fees are annual and renewals are due January 1st!
There is no prorated fee for joining part way through the year . E.g., if you are signing up for classes starting in December 2019 and wish to get the member class fee, you must join and pay for 2019. You will then need to renew for 2020 in January. It's still a great deal!
Lifetime members are required to complete the renewal form to ensure they maintain their status as Lifetime members.

NEW (effective October 16, 2018)

You can now pay for your membershipg using PayPal!

Date of Application *

Date

Membership Year *

Renewal or New *

Renewal New

Membership Type *

Single Family Lifetime (10+ yr.)

Name *

First Name Last Name

Additional Family Members *

	First Name	Surname (if different from Primary Member)	Under 18 yrs of age? Y or N
Family Member 2
Family Member 3
Family Member 4

Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

E-mail *

Telephone *

	Provide at least 1
Home
Mobile
Work

My contact information has changed *

No Yes Not Applicable

STATEMENT OF RESPONSIBILITY & WAIVER OF LIABILITY

I understand that:

agility training is an activity that is held in the presence of other dogs and their owners/handlers
the participation of my dog and myself in the agility training will require some physical activity on my part and on the part of my dog
this activity will involve running among obstacles on my part, and running, jumping, and the use of obstacles such as tunnels, scaling planks and walls, teeter totters, jumps, tires, and other obstacles which could result in injury to me, to my dog, or to others.

I agree, represent, and warrant:

1) That I am in good health and can perform the physical activities necessary.

2) That my dog is in good health and can perform the physical activities necessary.

3) That my dog and I are both in physical condition to participate in the sport of dog agility.

4) That I further represent that my dog is friendly and not a hazard to persons or other dogs. I agree to take any steps requested by my instructor, the class coordinator or the training director if they feel that my dog is a hazard to persons or other dogs.

5) That I further agree to keep my dog under control at all times, to carefully watch him at all times when he is not confined to a crate or other similar device, and not to allow him to interfere with the participation of others in classes and other club activities.

6) That I understand that I and my dog are participating at my own risk, and that Jumping Chollas Agility Club cannot in any way assume any responsibility for the health or safety or myself or my dog(s).

7) That I will not hold Jumping Chollas Agility Club, its Board of Directors and officers, the Owner(s) of the training sites, the agility instruction staff, or any other persons or entities associated with Jumping Chollas Agility Club liable for any loss, injury, illness, expense or other incident or hardship that may arise in connection with my participation and/or my dog’s participation in the activity.

8) That I further agree to assume full responsibility and liability for any and all injury or damage caused in any way by my dog(s) or myself. That I further agree to reimburse any person for any damage that I or my dog does or cause to another person, dog, equipment, or personal or business property.

I understand that, as a student or instructor training with Jumping Chollas, I have an obligation to help with equipment. In particular, if I attend the first class of the morning or evening, I must arrive at the designated time and help set up the equipment. I must help change jump heights during class. If I come to the late class, I must stay after class and help put the equipment away.

Statement of Responsibility & Liability Waiver *

I have read & agree to uphold.

Collection and Use of Personal Information - The Jumping Chollas Agility Club Inc. [JCAC] collects personal data including name, address, telephone and email information for the purpose of distributing materials and information relating to club business. The JCAC does not and will not share, publish, sell, or distribute personal information to/with other organizations without the written consent of its members. To help promote the club and answer enquiries from the public and general membership, Board Members/Directors agree to have their names published on the club’s website. All members agree to receive event notices and other information relating to club business via electronic means.

Personal Information Collection & Use *

I have read & agree.

Electronic Signature Agreement - By selecting the "I Agree and Accept" button below, you are signing this Application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Application.

Electronic Signature *

I agree and accept.

JCAC Membership Fee *

Single $20 Family $25 Lifetime $0

Payment Method *

PayPal Check Not Applicable - Lifetime Members Only!

Amt. Owing *

This field populates automatically.

Comments

PayPal Amount

USD JCAC Membership

HOW TO SUBMIT YOUR CHECK PAYMENT

Make checks payable to: Jumping Chollas Agility Club, Inc. (JCAC) and mail to:

JCAC-Membership
c/o Julie Grant
1515 West Encanto Blvd
Phoenix, AZ 85007

Renewals are due January 1.

JCAC Membership Form

Personal Information

Fees & Payment