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Hyperflite® skyhoundz®

Classic Qualifier

Separate form required for each handler PRE-REGISTRATION WITH PAYMENT IS *REQUIRED* to Compete. ABSOLUTELY NO EXCEPTIONS! DUE: May 15, 2016 Saturday, May 21, 2016

Jim Dietrich Park

Tab to each field to enter information. 4899 Stoudts Ferry Road, Reading, PA 19605

Registration 8:00 AM; Starts 9:00 AM

Select/Enter your Club Name

Handler:	Frank Montgomery
Address:	1120 Tyler Ave
City:	Annapolis	State:	MD	Zip Code:	21403
Phone:	410-263-7128	Email Address:	discnspot@aol.com
Competition City:	Reading, PA	Disc Dog Club Affiliation:

You can enter as many Events and Classes for which the team qualifies.

Enter Dogs with the most Event/Class Entries first. Only select the Class that is applicable to the Event selected. See guide on page 3.

Fees (per each Event/Class entered)
MAD Dogs Member	Non-Member
Dog1&2	$10	$15
Dog3 & >	$5	$10

Dog	Event **	Class ***	Pairs Freestyle 2nd Handler	Fee
Chicklet	10
Chicklet	10
Chicklet	10
Chicklet	10
Chicklet	David Gosch	10
Gracie Lou	10
Gracie Lou	10
Gracie Lou	Melanie Griggs	10
Bentley	5
Bentley	5
Bil Boy Blu	5
Total Fee	95

Release and Waiver of Liability

For and in consideration of my participation in the Hyperflite Skyhoundz / Mid Atlantic Disc Dogs 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: Hyperflite Skyhoundz, Inc, MAD Dogs, Inc, the administration and owner of the facility hosting the Event; together with the contractor, agents, employees and representatives of each of them. I certify that my canine and I are healthy and fit to compete in the Event.

I hereby grant to Hyperflite Skyhoundz and MAD Dogs 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 they may desire. I understand that Hyperflite Skyhoundz and MAD Dogs 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, but not limited to a television broadcaster) as they may desire without my further consent or knowledge and I expressly agree to such assignment.

Signature of	Parent or Guardian
Competitor	Date	Signature (under 18)	Date