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 10/08Class #’s
/ Sunday10/09
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 10/08Class #’’s / Sunday 10/09
Class #’s / Dogs
Name / Child / Youths
Name /
Child / Youths
Age& DOB / Entry FeesTotal 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______