Please Include This Form with the Liability Release and NAHRA Entry Form(S)

Please Include This Form with the Liability Release and NAHRA Entry Form(S)

CSHRC ENTRY FORM

Please include this form with the Liability Release AND NAHRA Entry form(s)

NAME: ______

ADDRESS: ______

PHONE and E-mail: ______

Total Dog Entries: Same dog cannot enter Intermediate and Hunter on same day

Beginner______X $15.00 = $______

Started ______X $55.00 = $______

Hunter ______X $60.00 = $______

Intermediate______X $65.00 = $______

Senior______X $70.00 = $______

Non-NAHRA Member Fee:

Number of Dog entries _____ X $10.00 = $______

Dinner @ $15/person ______x $15 $______

TOTAL PAYMENT: $______

Send this form, completed official NAHRA entry form(s) and liability release to:

Marylouise Cox

NAHRA Field Test Secretary

6856 E Phelps Rd

Scottsdale AZ 85254

COPPERSTATE HUNTING RETRIEVER CLUB

DOUBLE HEADER HUNTING RETRIEVER FIELD TEST

Licensed by the NORTH AMERICAN HUNTING RETRIEVER ASSOCIATION, INC.

In the Powers Butte section of the Robbins Butte Wildlife Area near Arlington, AZ

December 7 and 8, 2013

Entries: All entries must be made in advance and sent to:

Marylouise Cox, Test Secretary

6856 E Phelps Rd

Scottsdale, AZ85254

602-692-7817

Please make checks payable to CSHRC. Incomplete or late entries will not be accepted. Entries will close with the Test Secretary on Friday, November 22, 2013 at 5:00 pm. Drawing for the running order will take place immediately thereafter.

CATEGORYDATETIMEENTRY FEE**GAME______

Started I12/7/13 8:00 am$55.00Ducks and Pigeons

Hunter I12/7/13 8:00 am$60.00Ducks and Pigeons

Intermediate I12/7/13 8:00 am$65.00Ducks and Pigeons

Senior I12/7/13 8:00 am$70.00Ducks and Pigeons

Beginner12/7/13 10:00 am$15.00Ducks and Pigeons

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Started II12/8/13 8:00 am$55.00Ducks and Pigeons

Hunter II12/8/13 8:00 am$60.00Ducks and Pigeons

Intermediate II12/8/13 8:00 am$65.00Ducks and Pigeons

Senior II12/8/13 8:00 am$70.00Ducks and Pigeons

*******Non-NAHRA members please add an additional $10.00 per dog to your entry fee*****

JUDGES

Saturday, December 7

BeginnerJohn Geames

Started IRick Kail/Bob Tench

Hunter IRick Kail/Bob Tench

Intermediate IRick Kail/Bob Tench

Senior IKody Bull/Harry Williams

Sunday, December 8

Started IIKody Bull/Harry Williams

Hunter IIKody Bull/Harry Williams

Intermediate IIKody Bull/Harry Williams

Senior IIRick Kail/Bob Tench

PRIZES

OfficialNAHRA Rosettes and bands awarded to all Started, Hunter, Intermediate and Senior qualifying dog.

SCRATCHES

All scratches must be accompanied by a Veterinarian’s certificate if received after the closing date. Refunds for injuries or bitches in heat only.

FIELD TEST COMMITTEE

CHAIRPERSON: Randy Hutson

FIELD TEST SECRETARY:Marylou Cox

HEAD MARSHALL: JoAnnFroshaug

GUN CAPTAIN: Dean Swingle

BIRD STEWARD: Mike Edmonds

CLUB OFFICERS

PresidentRandy Hutson

Vice PresidentLance Sennette/Michael Elmer

TreasurerMary Trick

SecretaryMarylou Cox

FIELD TEST HEADQUARTERS

Field Test Headquarters will be at the gate parking lot adjacent to the main entry road to Powers Butte. Please check in with the Field Test Secretary before heading on to your stake.

LODGING

Best Western, 623-932-3210, 55 N. Litchfield RdGoodyear, AZ

Comfort Suites, 623-936-6000, 8421 W. McDowell Rd.Tolleson, AZ.

Days Inn of Buckeye, 623-386-5400, 25205 W. Yuma Rd.Buckeye, AZ

Ramada Inn, 623-932-9191, 1770 Dysart Rd. Goodyear, AZ.

Westward Motel, 623-386-4665, 945 E. Monroe Ave. Buckeye, AZ.

Wingate Inn & Suites, 623-547-1313, 1188 N. Dysart Rd., Goodyear, AZ.

Overnight parking for tents, trailers, and RVsavailable adjacent to the test site.

DIRECTIONS

From Phoenix: Drive West on I-10, exit on State Route 85 South to Gila Bend. After crossing Gila River bridge (about 3 miles) take first road West into Robbins Butte Wildlife Area.

From the West: Drive East toward Phoenix on I-10 and exit on State Route 85 South to Gila Bend. After crossing the Gila Riverbridge (about 3 miles) take the first road West into Robbins Butte Wildlife Area.

From the South: From Gila Bend on State Route 85 drive North to the turnoff to Robbins Butte Wildlife Area (about 4 miles North of the Lewis Prison complex). Turn west into the area.

MEALS

Breakfast andlunch will be available for purchase each day.

Catered-dinner and raffle immediately following the test on Saturday, December 7th. Dinner is $15/person including beverages and dessert..

Waiver of Liability: Copper State Hunting Retriever Club (CSHRC), the North American Hunting Retriever Association (NAHRA) and the owners/operators of the field test grounds are not responsible for any damages and/or injuries sustained to humans, animals and/or property while on the field test grounds or traveling to and from the field test grounds. All participants, spectators and guests recognize that this is an outdoor gunning event and attend at their own risk and agree to hold harmless CSHRC, NAHRA, their officers, the field test committee and the field test property owners/operators from any and all claims of personal property loss, damages and/or injury. A special waiver of liability form must be signed by each entrant at the test headquarters.

Copper State Hunting Retriever Club (CSHRC)

CSHRC Agreement and Release of Liability

(Please Note that we require an Agreement and Release of Liability for each person at our test.)

Executed (date) ______. Print name______.

Address______City______State______Zip______

County______Phone______

I (signature)______hereby acknowledge that I have voluntarily applied to participate or be a spectator in the sport shooting and/or dog hunt test activities conducted on the grounds of Powers Butte Wildlife Management Area, owned by the State of Arizona, in Arlington, AZ, and that these grounds will be used for the hunting of live birds with loaded firearms or the use of live/dead birds for simulated hunting dog activities. On December 7/8, 2013, these grounds will be used only for the use of live/dead birds for simulated hunting dog activities.” No actual hunting situations!

I am aware that hunting dog activities (where live guns and ammo are used) could be a hazardous activity and I am voluntarily participating or watching these activities with knowledge and appreciation of the danger involved and hereby agree to accept any and all risks of property damage, injury, or death. INITIAL______.

As LAWFUL CONSIDERATION for being permitted to participate in these activities and use these facilities, I agree that I, my heirs, distributes, guardians, legal representatives, and assigns WILL NOT MAKE A CLAIM AGAINST, SUE, ATTACH THE PROPERTY OF, OR PROSECUTE CSHRC, PROPERTY OWNERS, AGENTS AND AFFILIATED ORGANIZATIONS FOR INJURY TO MY PERSON OR DAMAGE TO MY PROPERTY RESULTING FROM THE PASSIVE OR ACTIVE NEGLIGENCE OR OTHER ACTS, HOWEVER CAUSED, by an agent, as a result of my participation in any of the activities conducted on the grounds listed above.

In addition, I hereby RELEASE AND DISCHARGE CSHRC, PROPERTY OWNERS, ITS AFFLIATED ORGANIZATIONS, OFFICERS, DIRECTORS, MEMBERS, from all actions, claims, or demands that I, my heirs, distributes, guardians, legal representatives, or assignees now have or may in the future have for an injury to my person or damage to my property resulting from my participation in sport shooting, hunting, or dog tests on the grounds listed.

Further, I hereby agree to COMPENSATE OR REIMBURSE CSHRC, property owners, affiliates, members of any organization for any claims brought against them for the property damage or personal injury or death which arise as a result of my passive or active negligence or other act(s) while participating in the activities in which I am involved.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND CONTRACT BETWEEN MYSELF, LAND OWNERS AND ANY OTHER ORGANIZATION AFFILIATED WITH THE DEMONSTRATION. I HAVE SIGNED THIS OF MY OWN FREE WILL FOR MYSELF AND FOR ANYONE WHOM I AM GUARDIAN OR PARENT OF WHO IS UNDER 18 YEARS OF AGE.

Signature______