Diggin’ West Challenge 2011 Entry Form

Owners Name______Fill out & Send to: Cheryl Costello

PO Box 130

Street ______Grants Pass, OR 97528

City______State______Zip______541-450-3237

Payable to:Diggin West Challenge

Phone and Email______Contact:Dawn Kelley, 559-664-0214

E-mail:

All Exhibitors must be current JRTCA Members. This includes all Children & Youth Exhibitors. Family membership $50

Pre-Entry by Sept. 24th $12Post-Entry after Sept. 24th $15All entries postmarked after 9/24/11will be considered Post Entries!

Saturday 10/08

Class #’s

/ Sunday
10/09

Class #’s

/

Terrier’s Full Name

/ Owner’s Name / Coat /
Height / Sex /
Age / DOB / Reg/Rec
Number / Entry Fee

I hereby enter the above at my own risk, and I hereby engage to be responsible for any injuries or damages that may occur to, or be caused by, animals, vehicles or trappings, or the loss

of any animals, vehicles or trappings exhibited by me and I further agree to be absolutely responsible for the physical condition of any animal under my control of ownership and will release, indemnify and save harmless the Diggin’West Challenge 2011 Trial, Madera County Fairgrounds, and the JRTCA, Inc. from any damage, expense, and/or liability arising out of or resulting from any acts of an exhibitor or Diggin West 2011 Trial, Madera County Fairgrounds, and the JRTCA, Inc. or their agents or employees. I hereby certify that my dogs are free from

contagious disease, and that I am not a member of a conflicting JRT Organization, nor do I register my Jack Russell Terriers with any conflicting JRT club or all-breed registry.

Ringside $25 Weekend ______Total Entry Fees ______

JRTCA $ 2/per dog / per day ______Total Youth Fees ______

Additional $5 per Dog Non- RegisteredR.V. / Camping $______Per night______Total______

or Non Recorded ______

Dinner reservation Sat. Night: yes or no / # ______

Sponsorships ______Total Enclosed ______

Signature______Date______Please include a copy of your 2011 JRTCA membership card and certificates.

Diggin’ West Challenge 2011 Entry Form

Youth

Parent/Guardian Name______Mail To:Cheryl Costello

PO Box 130

Street______Grants Pass, OR 97528

(541) 450 – 3237

(559) 664-0214,

Phone and Email______

Please make checks payable to: Diggin West Challenge

Entry: $12.00 per class or $20.00 for GTG & Conformation only.Entries must be postmarked by September 24th, 2011

Saturday 10/08
Class #’’s / Sunday 10/09
Class #’s / Dogs
Name / Child / Youths
Name /
Child / Youths
Age& DOB / Entry Fees

Total Youth Fees ______

Add to Adult Entry Form

I hereby enter the above at my own risk, and I hereby engage to be responsible for any injuries or damages that may occur to, or be caused by, animals, vehicles or trappings, or the loss of any animals, vehicles or trappings exhibited by me and I further agree to be absolutely responsible for the physical condition of any animal under my control of ownership and will release, indemnify and save harmless the Diggin’ West Challenge 2011 Trial, Madera County Fairgrounds, and the JRTCA, Inc. from any damage, expense, and/or liability arising out of or resulting from any acts of an exhibitor or Diggin’ West 2011 Trial, Madera County Fairgrounds, and the JRTCA, Inc. or their agents or employees. I hereby certify that my dogs are free from contagious disease, and that I am not a member of a conflicting JRT organization, nor do I register my Jack Russell Terriers with any conflicting JRT club or all-breed registry.

Signature______Date______JRTCA Number______