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| Application to Enter Super Comp September 2004 Name of Owner:_________________________ Dog's Name: ___________________________ Address: _______________________________ Registry Name: ________________________ State: _______________ Zip: __________ Registry Number: ______________________ Kennel Name: __________________________ Dog's Age: ________ DOB: _____________ Email Addy: ____________________________ Sex of Dog: ___________________________ Kennel Addy: ___________________________ Copy of Registry Papers Sent? __________ By signing this application, I understand that the organization providing these services will, in no way, be held liable for any physical injury of any kind being myself or my animal. And by signing this form, I release them from any liability for injuries that may occur while providing these services to me or any entry to any of these events. I also agree that ICA officials have the right to escort me off the premises should I not follow conduct rules, which I have fully read. If this happens, I understand I am not due any monies and/or refunds from the ICA. I also agree not to bring any cameras of any kind onto the property during this event. Cameras of any kind, include, but is not limited to: camcorders, phones that take pictures, cameras and / or any other types of equipment that takes still or moving pictures of any kind. Signed: ________________________________________ Date: ________________________ |