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Michiana Scent Work Club UpDog Challenge Disc Dog
Date: June 8th-9th, 2019
Event Address: Fair Oaks Farm, 856 N 600 E, Fair Oaks, IN 47943
Secretary Address: Angela Ogle, 404 Brookwood Court, Valparaiso, IN 46385
Contact: minis@wiggleb.com (219) 465-1624
Email address *
First & Last Name: *
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Phone Number *
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Street Address *
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City, State & Zip *
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Dog and Team Information *
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Registration Number *
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Dog 2: List dog's name, UpDog Team Number, and Jump Height (4", 8", 12", 16", 20", or 24")
Your answer
Dog 3: List dog's name, UpDog Team Number, and Jump Height (4", 8", 12", 16", 20", or 24")
Your answer
Dog 4: List dog's name, UpDog Team Number, and Jump Height (4", 8", 12", 16", 20", or 24")
Your answer
Dog 5: List dog's name, UpDog Team Number, and Jump Height (4", 8", 12", 16", 20", or 24")
Your answer
Dog 6: List dog's name, UpDog Team Number, and Jump Height (4", 8", 12", 16", 20", or 24")
Your answer
Games
Sat-Throw N Go
Sat-Four Way Play
Sat-Time Warp
Sat-Spaced Out
Sun-Frizgility
Sun-FunKey
Sun-7 Up
Sun-Far Out
Dog 1
Dog 2
Dog 3
Dog 4
Dog 5
Dog 6
Total Amount Owed $10 per game, $75 for 8 games (can be split between dogs). *
Your answer
Wavier
For and in consideration of my participation in the Michiana Scent Work Club’s above specified event (Event), and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I the undersigned, intending to be legally bound do hereby for myself, my heirs, assigns, executors, and administrators, waive and release any and all rights and claims for damages or injuries arising out of, or in any way related to, my participation in the Event, which I may have against the following parties: Michiana Scent Work Club, the administrator and owner of the facility hosting the Event; together with the contractors, agents, employees and representatives of each of them. I certify that my canine and I are healthy and fit to participate in the Event.I hereby grant to Michiana Scent Work Club the exclusive right to record, broadcast, photograph, film and videotape my performances and related interviews at the Event and to utilize such recordings, broadcasts, photographs, films or videotapes together with my name, image, likeness, voice, and biographical information, for such publicity, promotional or commercial purposes as the may desire. I understand that Michiana Scent Work Club may assign the right to use the recordings, broadcasts, images, photographs, film and videotape of my performance(s) together with my name, image, likeness, voice and biographical information to such person or other entity (including by not limited to a television broadcaster) as they may desire without my further consent or knowledge and I expressly agree to such assignment. *
I acknowledge that my registration is not complete until I send payment via paypal to: gizmogreentrees@yahoo.com https://www.paypal.com/us/home *
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