The 14^th Annual Rip Van Wrinkle Basenji Club Specialty Match, July 11^th, 2010

JUDGE: Sharon Beuhler ~ Held at the Stockade Polo & Saddle Club, Glenville, NY

PLEASE PRE-ENTER! - Early Entries close Saturday, July 5^th (Day of show entries will CLOSE AT 10 am - fees will go up to $12 first entry, $4 add’l entry of same dog.)

Dog's Name: _________________________________________Sex _________

Date of Birth:__________________________ Other than basenji?______________

o Musical Sits,

o Musical Downs,

o Best Yodeler

o Best Wrinkles

o Curliest Tail,

o 12^th Annual Bambi Memorial Veggie Eating Contest,

o Costume Class (My Favorite AVATAR)

o Parade of Veterans

o Parade of Rescues

o Parade of Title Holders

Pre-Entry Fees: $6 for first entry, $2 for each add’l entry of same dog, Parades always free.

Raffle for Basenji Health Endowment ~Tickets: 6 for $10.

1. Original pencil drawing, (Puppies in Basket) by Susan Kamen Marsicano

TOTAL: $_____.___ make checks to the Rip Van Wrinkle Basenji club & mail to:

Susan Marsicano, 12 Muse Road, Woodstock, NY 12498-2509

Owner's Name:___________________________________________Email____________

Address_________________________________________________Phone____________

I (we) waive any and all claims, causes of action, I (we) might otherwise have against the RVW club, and any approved judge, judging at this show. I (we) agree to hold this club, its members, directors, governors, officers, agents, superintendents or show secretary and the owner or lessor of the premises and any employees of the aforementioned parties harmless 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 this dog while in or upon the show, obedience or agility trial premises or grounds or near any entrance thereto; and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss of this dog by disappearance, theft, death or otherwise, and from any claim for damage or injury to the dog, whether such loss, disappearance, theft, damage, or injury be 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 (we) 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 (ourselves) on or account of damage to property, arising out of or in consequence of my (our) participation in this show, 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 persons.

I CERTIFY that I am the actual owner of the dog, and agree to be bound by “the Agreement” printed above. I (We) certify and represent that the dog entered is not a hazard to persons or other dogs. This entry is submitted for acceptance on the foregoing representation and agreement.

· Signed _________________________________________ Date________________