2009 Membership Application

 Club   Application Received (Date, Ck#) _____________________
Use     Attended Meeting (date)              _____________________
Only   Voted In (date)    __________________  Updated Roster ____________
Check      Renewal   (must be received by 2/28)
One:       New Applicant (attended meeting & be voted in)
Check    Self $20
One:        Family $30 (2 members/same address)
Your Name:  
Birthday:      
Work Phone:
Print work # in roster?        
Occupation:

Member #2 Name:
Birthday:        
Work Phone:
Print work # in roster?        
Occupation:

Street Address:       Home Phone:
City:                          State:          Zip:
Email:                
 List any skills/hobbies you/family members have that may benefit the club (sewing, woodworking, etc.):

Please list the dogs in your household (current agility participants as well as retired or up-and-coming dogs) and their current levels or titles in the following organizations:
Dog’s Call Name              Breed                        USDAA                   AKC                   NADAC

       
       
       
       

I agree to hold harmless the Dog Agility Racing Team (DART, hereafter referred to as “Club”), its members, officers, directors, agents, volunteers, the owner or lessor of any premises used for Club activities or training classes, sanctioning organizations, sponsors of any events, or any employees of the aforementioned parties from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of my dog(s) while in or upon the aforementioned premises or grounds or near any entrance thereto, and I personally assume all responsibility and liability for any such claim; and I further agree to hold the aforementioned parties harmless from any claim for loss, damage or injury of this (these) dog(s) by disappearance, theft, injury, death or otherwise, whether caused or alleged to be caused by the negligence of the Club or any of the parties aforementioned, or by the negligence of any other person, or any other cause or causes.
             I hereby assume the sole responsibility for and agree to indemnify and save the aforementioned parties harmless from any and all loss and expenses (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person including myself on or account of damage to property, arising out of or in consequence of my participation in any Club activities and training classes, howsoever such injuries, death or damage to property may be caused, and whether or not the same may have been caused or may have been alleged to have been caused by negligence of the aforementioned parties or any of their employees or agents, or any other person.
            I acknowledge that the Club activities, including but not limited to the sport of agility, require physical effort by both myself and my dog(s) I hereby certify that both my dog(s) and myself are capable of engaging in the physical demands of running, jumping and the uses of obstacles and equipment. I agree to assume all risk for injury or death to either my dog(s) or myself caused by my participation in Club activities.  Furthermore, I certify that my dog(s) are not a hazard to other persons or dogs and are in good health and up-to-date on all vaccinations consistent with current standards of veterinary care.

By submitting this application, I hereby certify that I will abide by the constitution and bylaws of the Club.

_________________________________                _________________                    ___________________________________                    ________________

SIGNATURE – MEMBER #1                             Date                                        SIGNATURE – MEMBER #2                        Date       

RETURN COMPLETED AND SIGNED APPLICATION, ALONG WITH A CHECK (MADE PAYABLE TO DART ) TO:       Tracy Lovelis, 10330 Finch Ave.. Alta Loma, CA 91737