Name *

First Name

Last Name

Handler Phone Number *

(###)

###

####

I am a MDSA Member *

Yes

No

Dog Gender *

Male

Female

Agreement and Liability *

I acknowledge that the MDSA Performance Guidelines have been made available to me, that I am familiar with their contents, and that I agree to abide by these Guidelines at this MDSA Freestyle Event. I waive any and all claims or causes of action I might otherwise have against MDSA and any MDSA-approved judge, judging of this event under MDSA Performance Guidelines. I agree that MDSA has the right to refuse this entry for cause, which MDSA shall deem to be sufficient. In consideration of the acceptance of this entry and of the holding of the freestyle event and of the opportunity to have the dog judged and to win ribbons, title certificates, or other awards, I agree to hold MDSA and its members, directors, governors, officers, agents, superintendents or 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 competition premises or grounds or near the entrance thereto, and I personally assume all responsibility and liability for any such claim; and I further agree to hold the aforementioned parties harmless for 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 MDSA or any of the parties afore-mentioned, 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 expense (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 or persons, including myself or on account of damage to property, arising out of or in consequence of my participation in this event, howsoever such injuries, death or damage to property may be caused, and whether or not the same may have been caused or may be alleged to have been caused by negligence of the afore-mentioned parties or any of their employees or agents or any other persons. I am aware that BMI, ASCAP and/or other music licensing agencies may be entitled to a fee for the use of licensed music in any public performance, including but not limited to this freestyle event. I agree to be solely responsible for any fees due and owing for the use of their music in this competition and agree to hold MDSA harmless and release MDSA from liability for same.

I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry, I agree to abide by the Performance Guidelines of the Musical Dog Sport Association governing a freestyle event and any decisions made by them, and further agree to be bound by the Agreement above. I certify and present that the dog entered is not a hazard to persons or other dogs. I further agree that the dog is entered in and will be at this event at my own risk and that I will hold MDSA and its members and agents free from liability for any claims arising out of the entry of the dog or its presence at the event. This entry is submitted for acceptance on the foregoing representation and agreement.