Owner/ Handler Information by HC120913105027


									BLAST January
    AAC Agility
                                                     Trial Secretary:
(Limited AAC Sanctioned Trial)                       Rebecca McKay

January 28 & 29                                    blastagility@yahoo.ca

                                          (Rubber Contacts & Breakaway tire
             2012                                   will be used)

Sturgeon Agriplex,
                                                LIMITED ENTRY
  (Indoor Heated on Dirt/Sand Surface)   Classes Offered:
                                         2 Jumpers, 2 Gamble, 2 Standards &
       Entries Open:                               1 Steeplechase

  December 5, 2011                                    ENTRY FEES:
                                                 $13 CAD per dog per class
      Entries Close:                     $1.00 from each run donated to the Alberta
                                                     AAC National Fund
   January 6th, 2012
                                            Mail Entries with Fees to:
                                                       (must be CAD $)

Kiersten Lloyd                                          Blast Agility
                                                   RR 3 Site 308 Comp 10
                                                   Onoway, AB, T0E 1V0
                Trial Secretary:                             Height Categories & Jump Heights
                                                             Please enter your dog at the applicable jump
              Rebecca McKay                                  height by measuring their height at the
                                                                                   HEIGHT DIVISION
              or 780– 497-8731                                 Shoulder Regular Special Veteran
           RR 3 Site 308 Comp 10                             = 12" or less 10"     6"        6"
                                                             > 12" ≤ 16" 16"       10"       6" / 10"
            Onoway, AB, T0E 1V0                              > 16" ≤ 21" 22"       16"       10" / 16"
                                                             > 21"         26"     22"       16" / 22"
       Mailed, Couriered and emailed will be accepted.
        Ensure that couriered entries do not require a       Directions to the Trial Site
        signature. All entries must be signed. Emailed       Route 1: Take Highway 28 north out of city, take the
        entries may be scanned then sent                     Cardiff/Sturgeon Agriplex turnoff by turning west (left)
       No faxed or hand-delivered entries.                  onto TWP 554, head towards the residential area, the
       Entries after the closing date may be accepted if    arena is on the left side of the road immediately right
        there is room still available in the trial but are   after the train tracks.
        subject to a $10.00 late fee per dog.
       Entries will be accepted based on the postmark       Route 2: Take HWY 2 north, take the Cardiff turnoff
        date or received date (for email). If entries        heading east (right) on TWP 554, drive past the Golf
        received with the same date pass the maximum         Club, the arena is on the right side just before the train
        number of runs per day, we will do a random          tracks.
        draw from those entries to the maximum
        number of runs per day being accepted.
                                                                 Accommodations - Pet Friendly Hotels
        AFTER THE CLOSING DATE. Move ups are                 Eastglen Inn
        permitted one (1) week prior to the date of the      6918 - 118 Avenue
        trial by notifying the Trial Secretary by email.     Edmonton
        Bitch in heat or injured dogs, and a valid           Toll Free: 1-888-411-2610
        veterinarian certificate must be provided prior      Rosslyn Inn & Suites
        to any refund being issued.                          13620 – 97 Street
                                                             Toll Free: 1-877-785-7005
                                                             Edmonton Inn
        Tentative Running Order:                             11830 Kingsway Avenue
(KL) = Judged by Kiersten Lloyd                              Edmonton
(SO) = Judged by Seanna O’Neill                              Toll Free: 1-800-661-7264
                                                             Chateau Louis Hotel
  Saturday                         Sunday                    11727 Kingsway Avenue
 Gamble 1 – Masters (KL),      Standard 2 – Starter (KL),    Edmonton
Advanced (KL) & Starters       Advanced (SO) & Masters       Toll Free: 1-800-661-9843
          (SO)                            (KL)               Travelodge Edmonton West
 Gamble 2 – Masters (KL),          Steeplechase (KL)         18320 Stony Plain Road
Advanced (SO) & Starters                                     Edmonton
          (KL)                                               Toll Free: 1-800-578-7878
Standard 1 – Masters (KL),     Jumpers 1 – Starter (SO),
Advanced (KL) & Starters       Advanced (KL) & Masters       Food
          (SO)                          (KL)                         More information to come on confirmation
                               Jumpers 2 – Starter (KL),
                               Advanced (SO) & Masters
                                                                                                                             AGILITY ASSOCIATION OF CANADA (“AAC”)
                                                                                                                             PARTICIPATION WAIVER AND RELEASE
January 28 – 29/2012                                                                                                         Handler Name: _________________________________
Entries Open: Dec 5/2011                                                                                                     Dog Name: (the “Dog”) __________________________
Entries Close: Jan 6/2012
                                                                                                                             AAC Dog ID#: ___________________________________
                                                                                                                             In consideration of the acceptance of this entry
Owner/ Handler Information                Has any of your information changed?      Yes           No                         by AAC and (the “Organizing Club”) BLAST
                                                                                                                             Agility and the opportunity to have the Dog
Owners Name:                                                                                                                 participate, compete in and/or be judged at this
                                                                                                                             event or trial (the “Event”), I, the undersigned,
Address:                                                            City:                                                    agree as follows:
                                                                                                                             1. I certify that I am the actual owner of the Dog,
Province:                Postal Code:                               Phone Number:                                            or that I am the duly authorized agent of the
                                                                                                                             actual owner of the Dog and that the Dog is not a
Email Address:                                                                                                               hazard to persons, property or other dogs.
                                                                                                                             2. I agree that AAC or the Organizing Club for the
Handler Info: (if different from Owner)                                                                                      Event may refuse my entry for any reason that it
                                                                                                                             deems to be sufficient.
                                                                                                                             3. I understand and acknowledge that
Dog 1 Information:     Changes?          Yes   No              Dog 2                Changes?           Yes   No              participation in the Event carries certain risks,
                                                                                                                             including, but not limited to injuries (including
                                                               Information:                                                  serous injuries and death) to myself, the Dog,
Dogs Name:             Breed:                                  Dogs Name:           Breed:                                   another dog under my control or persons
AAC #:                 Jump Height:                            AAC #:               Jump Height:                             attending as my guests (my “Related Parties”),
                          6” 10” 16” 22” 26”                                           6” 10” 16” 22” 26”                    damage to property and other losses. I waive any
                                                                                                                             and all claims that I have or may have in the
Birth Date:            Height at the Shoulder:                 Birth Date:          Height at the Shoulder:                  future against, and release from all liability and
Sex:                   Competing in:                           Sex:                 Competing in:                            agree not to sue AAC, the Organizing Club or any
   Female                 Regular         Special                 Female               Regular         Special               of the directors, executives, committees,
   Male                   Veteran                                 Male                 Veteran                               representatives, employees, volunteers or agents
                                                                                                                             of either AAC or the Organizing Club (the
                                                                                                                             “Personnel”) for any injury, death, property
Saturday               Dog 1 - Check Level:                    Saturday             Dog 2 - Circle the Level:                damage or other loss that I or my Related Parties
                                                                                                                             sustain due to any cause whatsoever, including
                                                                                                                             negligence, breach of contract, breach of duty,
    Gamble 1              Masters        Advanced    Starter       Gamble 1           Masters          Advanced    Starter
                                                                                                                             statutory or otherwise, or mistakes or errors of
                                                                                                                             judgment of any kind.
                          Masters        Advanced    Starter                          Masters          Advanced    Starter   4. I assume full responsibility for the conduct of
    Gamble 2                                                       Gamble 2                                                  myself and my Related Parties during the
                                                                                                                             entirety of the Event. I agree to indemnify and
    Standard 1            Masters        Advanced    Starter       Standard 1         Masters          Advanced    Starter   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
Sunday                                                         Sunday                                                        client basis) incurred by AAC, the Organizing
                                                                                                                             Club or the Personnel that may arise due to:
                          Starter    Advanced       Master                            Starter      Advanced       Master     (a) any act or omission of myself, my Related
    Standard 2                                                    Standard 2                                                 Parties or any party for whom I am liable at law;
    Steeplechase            All Levels                            Steeplechase            All Levels                         (b) aggressive behaviour by the Dog or any other
                                                                                                                             dog under my control.
                                                                                                                             5. I have read, and do understand the rules of
    Jumpers 1             Starter    Advanced       Master        Jumpers 1           Starter      Advanced       Master
                                                                                                                             competition and the additional rules (if any)
                                                                                                                             appearing in the trial schedule for the Event, as
    Jumpers 2             Starter    Advanced       Master        Jumpers 2           Starter      Advanced       Master     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
Fees                                                           Fees                                                          disciplinary procedures or sanctions for breach
13.00/ run x                    =                                            13.00/ run x                     =              of the Rules and agree to respect and be bound
                                                                                                                             by any disciplinary decision made by AAC.
                                                                                                                             6. I understand that AAC and/or the Organizing
                                                                                                                             Club may, in the course of administering the
Weekend Package=                                                              Weekend Package=                               Event or conducting its activities generally,
                                                                                                                             collect, use or disclose my personal information
                                                                                                                             and that any personal information collected,
   Fees Payable to:                                                           Any BLAST Bucks -                              used or disclosed by AAC and/or the Organizing
                                                                                                                             Club will be treated in accordance with AAC
   BLAST Agility                                                                                                             policy and applicable privacy and personal
   RR 3 Site 308 Comp 10                                                                                                     information laws. I hereby consent to the
                                                                                                       Total =               collection, use and disclosure by AAC and/or the
   Onoway, AB, T0E 1V0
                                                                                                                             Organizing Club of my personal information.
                                                                                                                             7. 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
        Weekend Package - Single Dog                                   Weekend Package – Multi Dogs                          that by signing this Agreement, I am restricting
               7 Runs for 86.00                                               7 Runs for 84.00                               my legal rights and I sign this Agreement
   **7 runs cannot be divided among dogs**                       ** 7 runs cannot be divided among dogs**                    voluntarily and of my own free will.

                                                                                                                             Signature: ___________________________________________
                                                                                                                             (Parent or Guardian must sign if the Handler is
                                                                                                                             under 18 years of age)

                                                                                                                             Date (mm/dd/yy): __________________________________

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