Tennessee Terrier Olympics I Entry Form

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Owner’s Name:                                         Street:                                              
Town:                       State:       Zip:           Phone:                      Email:                     		Fill out and send to:Lucy S. Ramey524 Lynn RoadBlountville, TN  37617-4900Make Checks Payable To: Tennessee Terrier Olympics
Entry Fees:      Pre                 Post$12.00
$17.00 		All Entries Postmarked after May 15, 2008 will be considered POST ENTRIES
Classes EnteredTerrier’s Full NameOwner’s NameSexAgeBirthDateHeight/ CoatJRTCA Reg#Entry Fee
         
         
         
         
         
         
         
For the Child & Youth Handler classes, please list the names and age of the HANDLER who will be exhibiting. All exhibitors and owners must be current JRTCA members. Please include a copy of your membership card with entries.

JRTCA Membership # __________________		I hereby enter the above at my own risk, and I hereby engage to be responsible for any injury or damages that may occur to, or be caused by, any animals, vehicles, or trappings or the loss of any animal, vehicles, or trappings exhibited by me, and I further agree to be absolutely responsible for the physical condition of any animal under my control of ownership and will release, indemnify, and save harmless the Tennessee Terrier Olympics, Appalachian Fairgrounds, Gray, TN, Terrier Trial and the JRTCA, Inc. from any damage, expense, and/or liability arising out of or resulting from any act of the Exhibitor or the Tennessee Terrier Olympics, Appalachian Fairgrounds, Gray, TN, Terrier Trial or their agents or employees. I hereby certify that my dogs are free from contagious disease, and that I am not a member of a conflicting JRT organization, nor do I register my Jack Russell Terriers with any conflicting JRT Club or all-breed registry.   Signature:                                     Date:      Total Entry Fees:              JRTCA AdministrativeFee ($2.00 per dog):           Total Enclosed: