DEPARTMENT G OPEN SWINE JACKPOT SHOW

Size: px
Start display at page:

Download "DEPARTMENT G OPEN SWINE JACKPOT SHOW"

Transcription

1 DEPARTMENT G OPEN SWINE JACKPOT SHOW Superintendent Kurtis Kolb (309) Asst. Superintendents Mitch Wilson (815) , Larry Kolb (309) , Barry Stutzman (815) & Ryan Nenne (815) Grounds Fees: $3.00 per head Additional Premiums Offered - $2349 Entry Fees: $20.00 per head Check-In: 6pm-7:30pm Saturday, July 14 th, 2018 and 7am-9am Sunday, July 15 th, 2018 *All barrow and gilt cards must be turned in by 9am. Sunday Show: 10:30am (Showmanship, Purebred Gilts, Crossbred Gilts, Barrows) Show Guidelines: *Showmanship: 3 Divisions *All entries farrowed on or after January 1 st, 2018 *Registration papers required on ALL purebred entries and must be transferred to the exhibitor s name *Health papers required for ALL entries *A Certificate of Veterinarian Inspection no more than 90 days past the date of issuance is required for instate hogs. A CVI no more than 30 days past the date of issuance is required for out-of-state hogs. Out-ofstate animals will also need an entry permit number on the CVI. *Purebred Gilt Classes Divided by Age; Barrow and Crossbred Gilt Classes Divided by Weight -Barrows and Crossbred Gilts weigh cards must be turned in by 9am on Sunday, July 15 th, 2018 Declare weight on barrows and crossbred gilts. Top 2 placing hogs will be reweighed in each barrow and crossbred gilt class. **6% weight back** *Min. and Max. Weight Ranges: Barrows: 190lbs-300lbs Crossbred Gilts: 190lbs-350lbs *No limit on the number of entries per exhibitor *Exhibitors must bring their own bedding shavings only NO STRAW *It takes 4 head to make a breed class. If less than 4 in a breed, they will show as AOB S *Must have 8 head in a breed to split a class *Pens are first come, first served. Pens fill quickly! *Rule of the Swine Department and Superintendent will be final *NO REFUNDS

2 DEPARTMENT G - GILTS PUREBRD GILT CLASSES Section Number Gilts Class # 1 st 2 nd 3 rd 4 th 5 th 6 th 7 th Section 1-Berkshire % 25% 20% 15% 5% $4.50 $4.00 Section 100- Berkshire Champion 1 $40 Section 100- Berkshire Reserve Champion 2 $20 Section 1-Chester White % 25% 20% 15% 5% $4.50 $4.00 Section 100- Chester White Champion 11 $40 Section 100- Berkshire Reserve Champion 12 $20 Section 1-Duroc % 25% 20% 15% 5% $4.50 $4.00 Section 100- Duroc Champion 21 $40 Section 100- Duroc Reserve Champion 22 $20 Section 1-Hampshire % 25% 20% 15% 5% $4.50 $4.00 Section 100- Hampshire Champion 31 $40 Section 100- Hampshire Reserve Champion 32 $20 Section 1-Poland China % 25% 20% 15% 5% $4.50 $4.00 Section 100- Poland China Champion 41 $40 Section 100- Poland China Reserve Champion 42 $20 Section 1-Spotted Poland China % 25% 20% 15% 5% $4.50 $4.00 Section 100- Spotted Poland China Champion 51 $40 Section 100- Spotted Poland China Res Champ 52 $20 Section 1-Yorkshire % 25% 20% 15% 5% $4.50 $4.00 Section 100- Yorkshire Champion 61 $40 Section 100- Yorkshire Reserve Champion 62 $20 Section 1-Hereford & Landrace % 25% 20% 15% 5% $4.50 $4.00 Section 100- Herford & Landrace Champion 71 $40 Section 100- Hereford & Landrace Res Champion 72 $20 Section 100- Grand Champion Purebred Gilt 80 $200 Section 100 Res Grand Champion Purebred Gilt 81 $100 DEPARTMENT G1 CROSSBRED MARKET GILTS MARKET GILT CLASSES Section Number - 1 Market Gilts Class # 1 st 2 nd 3 rd 4 th 5 th 6 th 7 th Section 1-Crossbred % 25% 20% 15% 5% $4.50 $4.00 Section 100- Grand Champion Crossbred Gilt 100 $200 Section 100 Res Grand Champion Crossbred Gilt 101 $100

3 DEPARTMENT G3 - BARROWS BARROW CLASSES At least 1 of the top 3 Overall Barrows must be a Purebred. Section Number Barrows Class # 1 st 2 nd 3 rd 4 th 5 th 6 th 7 th Section 1-AOB Barrow % 25% 20% 15% 5% $4.50 $4.00 Section 100- AOB Champion 1 $40 Section 100- AOB Reserve Champ 2 $20 Section 1-Duroc Barrow % 25% 20% 15% 5% $4.50 $4.00 Section 100- Duroc Champion 11 $40 Section 100- Duroc Reserve Champion 12 $20 Section 1-Hampshire Barrow % 25% 20% 15% 5% $4.50 $4.00 Section 100- Hampshire Champion 21 $40 Section 100- Hampshire Reserve Champion 22 $20 Section 1-Yorkshire Barrow % 25% 20% 15% 5% $4.50 $4.00 Section 100- Yorkshire Champion 31 $40 Section 100- Yorkshire Reserve Champion 32 $20 Section 1-Crossbred Barrow % 25% 20% 15% 5% $4.50 $4.00 Section 100-Crossbred Champion 41 $40 Section 100- Crossbred Reserve Champion 42 $20 Section 100- Grand Champion Barrow Overall 50 $500 Section 100- Res Grand Champion Barrow Overall 51 $200 Section rd Overall Barrow 52 $150 Dept. G-SWNE SECTION 99 - SHOWMANSHIP Junior Showmanship, ages 8 through 10 years* Intermediate Showmanship, ages 11 through 13 years* Senior Showmanship, ages 14 and over* Showmanship classes are open to exhibitors having entries in any of the classes in the Swine Department. NO ENTRY FEE FOR SHOWMANSHIP CLASSES. Show Order: Showmanship Purebred Gilts-Berkshire Chester White Duroc Hampshire Poland China Spotted Poland China Yorkshire Hereford & Landrace Crossbred Gilts-3 Classes Barrows AOB S Duroc Hampshire Yorkshire Crossbred

4 OPEN JACKPOT GILT & BARROW SHOW ENTRY FORM ALL EXHIBITORS MUST SIGN THE WAIVER LOCATED ON THE BACK OF THE ENTRY FORM OR ON THE FOLLOWING PAGE OF THE BOOK. Exhibitor LEGAL Name: Address: City: State: Zip: Home Phone: Cell: Exhibitor s Social Security No. - - I certify that the above informaiton is correct. (No premiums will be paid if social security number is not included.) Signature: Date: Dept. Section Class Description 1. 1 BREEDING GILT BIRTHDATE EAR NOTCH Premises ID # ENTRY FEES: # of Head Entered x $20 per head = $ PEN FEES: # of HEAD Entered x $3 per stall = $ TOTAL ENTRY FEES DUE $ **Mail entry forms to: Marshall-Putnam Fair-915 University Avenue-PO Box 114-Henry Illinois 61537** * Make checks payable to: Marshall-Putnam Fair* **NO REFUNDS** All Exhibitors MUST sign and return Release and Waiver of Liability and Indemnity Agreement (located on next page)

5 Release and Waiver of Liability and Indemnity Agreement Marshall-Putnam Fair Association In Consideration of being permitted to enter for any purpose any part of the property of the Marshall-Putnam Fair Association, and/or in consideration of being permitted to compete, officiate, observe, work for, or for any purpose participate in any way in any events being conducted at the Marshall-Putnam Fair Association. EACH OF THE UNDERSIGNED, for himself, his personal representatives, heirs, and next of kin, acknowledges, agrees and represents that he has, or will immediately upon entering any part of such property, and will continuously thereafter, inspect such property and all portions thereof which he enters and with which he comes in contact, and he does further warrant that his entry upon such property and his participation, if any, in the event constitutes an acknowledgment that he has inspected such property area and that he finds and accepts the same as being safe and reasonably suited for the purposes of his use, and he further agrees and warrants that if, at any time he is in or about such property and he feels anything to be unsafe, he will immediately advise the officials of the Marshall-Putnam Fair Association of such and will immediately leave the area. In further consideration of the foregoing, the undersigned agrees as follows: 1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the promoter, participants, racing association, sanctioning organization or any subdivision thereof, track operator, track owner, officials, car owners, drivers, pit crew, any persons in any restricted area, promoters, sponsors, advertisers, owners and lessees of premises used to conduct the event and each of them, their officers and employees, the Marshall-Putnam Fair Association, or its directors, officers, or employees, all for the purposes herein referred to as "releases", from all liability to the undersigned, his personal representatives, assign, heirs, and next of kin, for any and all loss or damage, and any claim or demands therefore on account of injury to the person or property of or resulting in death of the undersigned, whether caused by the negligence of the releases, or otherwise, while the undersigned is in or upon the aforesaid areas, and/or, competing, officiating in, observing, working for, or for any purpose participating in any of said events. 2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in or upon the area or in any way competing, officiating, observing or working for, or for any purpose participating in any event and whether caused by the negligence of the releases or otherwise. 3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releases or otherwise while in or upon the said areas and/or while competing, officiating, observing, or working for or for any purpose participating in any event. EACH OF THE UNDERSIGNED EXPRESSLY ACKNOWLEDGES and agrees that the activities of the event are very dangerous and involve the risk of serious injury and/or death and/or property damage. Each of the undersigned further expressly agrees that the foregoing Release, Waiver, and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Illinois and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTAIRLY SIGNS THE RELEASE AND WAIVER OR LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representation, statements or inducements apart from the foregoing written agreement have been made. Signature Print Name Parent Signature (If entrant is under 18 years) Failure to sign this release automatically voids your entry.

Photography is now located under Department M3

Photography is now located under Department M3 DEPARTMENT M1 - FINE ARTS Superintendents - Lori DeWeerth and Michelle Rolando (Sections 1-10) Total M1 Fine Arts Premiums Offered - $666.00 Exhibitor's Permit - $6.00 per department with a maximum of

More information

ALL DRIVERS MUST COMPLETE INFORMATION BELOW

ALL DRIVERS MUST COMPLETE INFORMATION BELOW Mailing Address: PO Box 322 Lancaster, NY 14086 Phone: 716-759-6818 Website: LancasterNationalSpeedway.com 2018 STOCK CAR REGISTRATION, MEMBERSHIP & NUMBER APPLICATION PLEASE PRINT LEGIBLY ALL DRIVERS

More information

Presents the Prairie Days Parade

Presents the Prairie Days Parade Presents the Prairie Days Parade Saturday June 23, 2018 @ 9:30am Line up by 8:00am ~ Judging @ 9:00am Theme: Mail application to: Yelm Area Chamber of Commerce, PO Box 444, Yelm, WA 98597 or email to info@yelmchamber.com----application

More information

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree: WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event described below, I agree: 1. I acknowledge that motor vehicle activity is a potentially

More information

Ogden Cycle Association Membership Agreement

Ogden Cycle Association Membership Agreement Date: Ogden Cycle Association Membership Agreement Membership Type: (mark all that apply) Single Family Non-Wor king Charter Life Cash / Check # Amount Paid $ Receipt # New Member / Annual Renewal I agree

More information

SCCA Rally/Solo Release and Waiver Guidelines

SCCA Rally/Solo Release and Waiver Guidelines RISK MANAGEMENT I. Introduction SCCA Rally/Solo Release and Waiver Guidelines These guidelines are intended to provide basic information regarding release and waiver procedures for ALL non-club or SCCA

More information

PRINTING INSTRUCTIONS

PRINTING INSTRUCTIONS PRINTING INSTRUCTIONS All forms must be printed in COLOR on standard 8.5 x 11 paper. Black and white or illegible copies will NOT be accepted. 1. The MINOR VEST APPLICATION is a one (1) page form. 2. The

More information

Volunteer Application

Volunteer Application Memorial and Museum 62 Battleship Place Camden, New Jersey 08103 Volunteer Application Name: Address:. Telephone: Home ( ) Cell ( ) Email: Area(s) of Interest: Referred by: Please complete the attached

More information

TEAM CONTACT: CONTACT PHONE: (Cell) (Home) ADDRESS: MAILING ADDRESS: CITY: STATE: ZIP:

TEAM CONTACT: CONTACT PHONE: (Cell) (Home)  ADDRESS: MAILING ADDRESS: CITY: STATE: ZIP: SOUTH GEORGIA BBQ & OUTDOOR FESTIVAL 5 TH ANNUAL DOUGLAS BBQ COOK-OFF 2018 APPLICATION The team s Pit Master has to be a Georgia BBQ Association members, prior to competition. GBA individual membership

More information

Entry Form Idaho Regatta June 22-24, 2018

Entry Form Idaho Regatta June 22-24, 2018 Entry Form Idaho Regatta June 22-24, 2018 For Info call: Louis Schindler (760) 831-2325 Email: louisschindler2@gmail.com Website: www.idahoregatta.org Driver Name First Address City State Zip Phone ( )

More information

Trans Am/SCCA Pro Racing Competition License and Annual Credential Application

Trans Am/SCCA Pro Racing Competition License and Annual Credential Application Applicant Information: Trans Am/SCCA Pro Racing Competition License and Annual Credential Application Name: Birthdate: Phone: Address: SCCA Member #: City: State: Zip: E-mail Address: Emergency Contact:

More information

UNITED STATES AUTO CLUB

UNITED STATES AUTO CLUB UNITED STATES AUTO CLUB 2015.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK

More information

ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018

ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 POLICIES Cost: Full Week (5 Days) $115, Half Week (3 Days) $70; Additional Children: Any additional children will receive a $10 discount on full weeks ONLY. Registration

More information

GRB Rigging Approval Form

GRB Rigging Approval Form GRB Rigging Approval Form All rigging and/or hanging requests are only authorized for installation if this form has been countersigned and drawings have been approved by the George R. Brown Convention

More information

It s ROAD-E-O time! STATE Landfill Equipment ROAD-E-O: JUNE 15, 2013 Location: Republic s Benson Valley Landfill, 2157 Highway 151, Frankfort, KY

It s ROAD-E-O time! STATE Landfill Equipment ROAD-E-O: JUNE 15, 2013 Location: Republic s Benson Valley Landfill, 2157 Highway 151, Frankfort, KY It s ROAD-E-O time! The SWANA ROAD-E-O is designed to enhance employee morale, instill a competitive spirit, and encourage superior performance among the solid waste drivers and equipment operators at

More information

2018 Racing for Relief Inc. Go-Kart Racing

2018 Racing for Relief Inc. Go-Kart Racing 2018 Racing for Relief Inc. Go-Kart Racing TEAM ENTRY FORM (Deadline is April 14, 2018 to have team & sponsors listed in the program) Proceeds to benefit the Racing for Relief, Inc. PO Box 384 St Henry,

More information

Hamilton and Friends Musical Theatre Camp

Hamilton and Friends Musical Theatre Camp JULY 9-20 SUMMER of 18! (Ages 9-13) Registration Form: $375.00/wk Early Bird Rate (now - March 1) $400.00/wk Standard Rate (beginning March 2) Child s Name: Date of Birth: Age: School Grade in the Fall:

More information

2017/18 Out of School Program Registration Form

2017/18 Out of School Program Registration Form 2017/18 Out of School Program Registration Form Child: First Name MI Last Name YMCA Member Non Member E-mail NOTE: There is a one time, non-refundable $20 registration fee per child required to secure

More information

UNITED STATES AUTO CLUB

UNITED STATES AUTO CLUB UNITED STATES AUTO CLUB 2016.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK

More information

Name of Group: Reservation Date: Zip: Phone (w) (h) Departure Time Person in Charge: # Expected Ages

Name of Group: Reservation Date: Zip: Phone (w) (h) Departure Time Person in Charge: # Expected Ages Dear Thank you for choosing the YMCA for your gathering. We are happy to have you and your group at our facility. Your group is scheduled to arrive on at. Enclosed you will find the Regulations for Use

More information

Instructions for Completing Ford DSFL Waivers

Instructions for Completing Ford DSFL Waivers Instructions for Completing Ford DSFL Waivers 1) Print out the four (4) forms attached. (Print in color if possible) 2) All 4 forms must be filled in COMPLETELY. If forms are not completed and signed properly

More information

2016 5K Reindeer Run/Walk Team Registration

2016 5K Reindeer Run/Walk Team Registration 2016 5K Reindeer Run/Walk Team Registration Team Registration Forms and Waiver must be fully completed and received by December 2 nd in order to receive the $20/person group rate; Minimum of 3 people per

More information

The Venture Free Foundation

The Venture Free Foundation The Venture Free Foundation 2017-2018 After School Program Mission Our mission at Venture Free is Empowering young people to foster a connection with the natural world in an environment that promotes healthy

More information

DIVE IN! Speed Demons Swim Team. Fulton Family YMCA 715 W. Broadway Fulton, NY Phone:

DIVE IN! Speed Demons Swim Team. Fulton Family YMCA 715 W. Broadway Fulton, NY Phone: DIVE IN! 2018-2019 Speed Demons Swim Team Fulton Family YMCA 715 W. Broadway Fulton, NY 13069 Phone: 315-598-9622 www.fultonfamilyymca.org 2018-2019 Fulton Speed Demons Registration Participant Name: Date:

More information

THE KANSAS INDOOR ROWING CHAMPIONSHIPS XXIX

THE KANSAS INDOOR ROWING CHAMPIONSHIPS XXIX THE KANSAS INDOOR ROWING CHAMPIONSHIPS XXIX Saturday February 26, 2011 Lyman Elementary School 2032 N. Kansas Ave. Topeka, Kansas 9:00AM to Noon! All races are Finals (with Flights as needed) Events for

More information

Before and After School Care

Before and After School Care Before and After School Care BLAIR FAMILY YMCA 2016-2017 School Year Registration Forms To put Christian principles into practice through programs that build a health spirit, mind and body for all. -YMCA

More information

MEMBERSHIP APPLICATION WE RE A CAUSE WE RE MORE THAN A GYM. YMCA of Broome County

MEMBERSHIP APPLICATION WE RE A CAUSE WE RE MORE THAN A GYM. YMCA of Broome County MEMBERSHIP APPLICATION WE RE MORE THAN A GYM WE RE A CAUSE YMCA of Broome County MEMBERSHIP RATES Membership Type Monthly Payment Annual Payment (automatic withdrawal) First payment will be pro-rated based

More information

The Ocala Jeep Club of Florida Inc. with Phillips Chrysler Jeep Dodge Ram & The Market of Marion Present the Southeast s Best 3 day Jeep Exclusive

The Ocala Jeep Club of Florida Inc. with Phillips Chrysler Jeep Dodge Ram & The Market of Marion Present the Southeast s Best 3 day Jeep Exclusive The Ocala Jeep Club of Florida Inc. with Phillips Chrysler Jeep Dodge Ram & The Market of Marion Present the Southeast s Best 3 day Jeep Exclusive Show Proceeds benefit: Interfaith s Food for Kids, Ronald

More information

FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics.

FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics. FACILITY RENTAL APPLICATION *Application approval is based on facility availability, staffing demands and event specifics. Name/: Date & Day of Event: Start Time: End Time: *see page 2 for set times available

More information

HELPING TEENS THRIVE. Youth & Government CENTRAL YMCA

HELPING TEENS THRIVE. Youth & Government CENTRAL YMCA HELPING TEENS THRIVE Youth & Government CENTRAL YMCA LEARN MORE WHAT IS YOUTH & GOVERNMENT? Learn first-hand how our state government works not by watching, but by doing! Each September for six months,

More information

2019 OWNER / DRIVER / CREW APPLICATIONS

2019 OWNER / DRIVER / CREW APPLICATIONS Application Summary: 2019 Owner License: The fee for a 2019 Modified Racing Series Owners license is $250.00 (two-hundred fifty dollars). An Owner s License gives the owner rights to a car number until

More information

HAWAII JUDO ACADEMY Building Champions for Success at All Levels in Life

HAWAII JUDO ACADEMY Building Champions for Success at All Levels in Life 10AM 11AM CLASS SCHEDULE Monday Tuesday Wednesday Thursday Friday Saturday Training (Kids &Adult) 10:00-12:00) 12AM 1 PM 4PM Kids Intro 4:30-5:00 5 PM Kids Kids 1 5:00-7:00 5:00-6:10 6 PM Kids 2 6:15-7:25

More information

1. MMDS Inc. will conduct an instructional driving program (Program) for, (Students name).

1. MMDS Inc. will conduct an instructional driving program (Program) for, (Students name). THIS AGREEMENT is entered into on the day of 20, by and between Max Maxwell Motorsports & Driving School, Inc. (hereafter referred to as "MMDS Inc. ) And (Students Name) (Hereafter referred to as student

More information

PERSONAL INFORMATION CAR INFORMATION. Car Number: Car Owner:

PERSONAL INFORMATION CAR INFORMATION. Car Number: Car Owner: 2019 Sprint Car Bandits (SCB) COMPETITOR APPLICATION This form must be completed before any driver pay will be issued. Please print clearly. All fields on application must be completed. Completion of form

More information

2017 Minor Crew Check-List

2017 Minor Crew Check-List 2017 Minor Crew Check-List Following you will find the necessary forms to complete your 2017 IMSA Membership/License application and Annual hard card application. This checklist is meant to assist you

More information

2019 SUMMER DAY CAMP REGISTRATION

2019 SUMMER DAY CAMP REGISTRATION 2019 SUMMER DAY CAMP REGISTRATION Child: First Name MI Last Name [ ] YMCA Member [ ] Non Member Email Enrollment Date SUMMER DAY CAMPS CHOOSE YOUR CAMPS & LOCATION: [ ] Ages 5-12 (must have attended kindergarten)

More information

RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT

RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT Available with permission from YMCA Services Corporation Copyright 2005 YMCA Services Corporation All Rights Reserved

More information

WRAP/YMCA Expanded Learning Program

WRAP/YMCA Expanded Learning Program 2018-2019 School Year School: Child s Last Name: First Name: Sex: M F Birth date: / / Age: Home Phone: ( ) Home Address: Cell Phone: ( ) City: State: Zip: Child lives with: Mom Dad Both Parents Other Begin

More information

FLAGSTAFF FAMILY YMCA AFTER SCHOOL ADVENTURES

FLAGSTAFF FAMILY YMCA AFTER SCHOOL ADVENTURES FLAGSTAFF FAMILY YMCA 2018-2019 AFTER SCHOOL ADVENTURES Child s name Birth date Grade Age Parent s name Birth date (Required for registration) Address City AZ Zip code Home # Work # Cell# Parent s E-mail

More information

Open Nationals. A.O.K. A Rated

Open Nationals. A.O.K. A Rated Grandmaster Linda Denley & TBB Academy present The 40th annual SPACE CITY Open Nationals LINDA DENLEY April 14 HOUSTON The Texas Terror Rated #1 from 1973-1996 11-time Battle of Atlanta WInner 3-time Diamond

More information

MIAMI ROWING & WATERSPORTS CENTER, INC Membership (6 pages) Application For:

MIAMI ROWING & WATERSPORTS CENTER, INC Membership (6 pages) Application For: MIAMI ROWING & WATERSPORTS CENTER, INC. 2017 Membership (6 pages) Application For: FAMILY MEMBERSHIP: Initiation Fee: $500.00 Monthly Dues: $110.00 Annual Due $1320.00 Equipment Fund Monthly Due $15.00

More information

MEMBERSHIP APPLICATION WE RE A CAUSE WE RE MORE THAN A GYM. YMCA of Broome County

MEMBERSHIP APPLICATION WE RE A CAUSE WE RE MORE THAN A GYM. YMCA of Broome County MEMBERSHIP APPLICATION WE RE MORE THAN A GYM WE RE A CAUSE YMCA of Broome County MEMBERSHIP RATES Membership Type Monthly Payment Annual Payment (automatic withdrawal) First payment will be pro-rated based

More information

O*H*I*O MASTERS SWIM CLUB (Old Hearts Inspiring Others) CLEVELAND - WEST SIDE Swim Workouts WINTER, 2017

O*H*I*O MASTERS SWIM CLUB (Old Hearts Inspiring Others) CLEVELAND - WEST SIDE Swim Workouts WINTER, 2017 O*H*I*O MASTERS SWIM CLUB (Old Hearts Inspiring Others) CLEVELAND - WEST SIDE Swim Workouts WINTER, 2017 COACHED WORKOUTS for WINTER 2017 - We offer workouts overseen by experienced coaches. All adult

More information

Burnouts Blown Open: Powerskids Cruise the Track. Entrant Name: Postal Address: Address: Mobile Number: Phone: (W/H) AASA License:

Burnouts Blown Open: Powerskids Cruise the Track. Entrant Name: Postal Address:  Address: Mobile Number: Phone: (W/H) AASA License: All Entrants MUST provide a clear external (front-on) photograph of their vehicle, as spots are limited. West Coast Nats reserves the right to refuse entry to any vehicle as Entrant numbers are capped

More information

2019 Membership Packet

2019 Membership Packet 2019 Membership Packet Membership Checklist TASK Get USA Waterski Insurance http://usawaterski.org/pages/join.html You MUST have continuous coverage from February 1 st - October 1 st. No insurance = no

More information

YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form

YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form PARTICIPANT INFORMATION: YMCA of the Coastal Bend Summer Camp 2018 Enrollment Form Child (1) Name: Sex: [M] [F] (circle one) of birth: / / Camp Type/Location: YMCA Day Camp (Pre-K - 5 th ) Downtown YMCA

More information

DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT

DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT DANVILLE FAMILY YMCA MEMBERSHIP CONTRACT 1 Name (First, Last): Date of Birth: Gender: Email: Address: City: State: Zip Code: Phone (Home): Cell: Work: Place of Employment/School: Emergency Contact: Phone:

More information

ASTROS RBI FORMS CHECKLIST PARTICIPANT NAME: PARTICIPANT DATE OF BIRTH: / / CONTACT PHONE NUMBER: CONTACT

ASTROS RBI FORMS CHECKLIST PARTICIPANT NAME: PARTICIPANT DATE OF BIRTH: / / CONTACT PHONE NUMBER: CONTACT -ALLTRYOUTSAT URBAN YOUTH ACADEMY 2801S.Vi ct orydr. ;Hous t on,tx 77088 PREREGI STER ONLI NEAT: ASTROS. COM/ UYA FOR OFFICE USE ONLY DIVISION: SOFTBALL JUNIOR SENIOR TRYOUT NO. ASTROS RBI FORMS CHECKLIST

More information

Subsidized after school slots requires participant to attend the after school program 5 days/week and stay until 5:30PM

Subsidized after school slots requires participant to attend the after school program 5 days/week and stay until 5:30PM Sunnyside Elementary After School Program Registration 2016-2017 School Year SECTION A: PROGRAM SITE AND SCHEDULE School: Sunnyside Elementary After School Program Monday Tuesday Wednesday Thursday Friday

More information

OBSERVED HOLIDAYS No classes

OBSERVED HOLIDAYS No classes 1 114 E Oak Ave Visalia, CA 93291 (559) 627-8277 spacpp@att.net www.spacdance.com @WeTrainDancers Student Enrollment form Please fill out for each student Student Name (First) (Last) Address (Town) (Zip)

More information

1. MMDS Inc. will conduct an instructional driving program (Program) for, (Students name).

1. MMDS Inc. will conduct an instructional driving program (Program) for, (Students name). THIS AGREEMENT is entered into on the day of 20, by and between Max Maxwell Motorsports & Driving School, Inc. (hereafter referred to as "MMDS Inc. ) And (Parents Name) (Hereafter referred to as Parent

More information

Hoover High School Invitational Regatta Hoover Reservoir Westerville, Ohio Saturday, April 12, 2003 Hosted by Westerville Crew

Hoover High School Invitational Regatta Hoover Reservoir Westerville, Ohio Saturday, April 12, 2003 Hosted by Westerville Crew Hoover High School Invitational Regatta Hoover Reservoir Westerville, Ohio Saturday, April 12, 2003 Hosted by Westerville Crew COURSE The racecourse is a 1500-meter course on Hoover Reservoir in Westerville,

More information

ADULT COACHING APPLICATION

ADULT COACHING APPLICATION - MIAMI ROWING & WATERSPORTS CENTER, Inc. ADULT COACHING APPLICATION -MEMBER HRLY Private lessons where non-members and members can come and row in a one-on-one session tailored to your skill level and

More information

2018 INEX MEMBERSHIP APPLICATION

2018 INEX MEMBERSHIP APPLICATION 2018 INEX MEMBERSHIP APPLICATION ONE FORM PER APPLICANT THE ACCEPTANCE OF THIS APPLICATION AND FEE BY INEX DOES NOT CONSTITUTE MEMBERSHIP APPROVAL. INEX MAY DENY MEMBERSHIP TO ANY APPLICANT FOR ANY REASON.

More information

2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS

2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS 2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions

More information

2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS

2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions

More information

To: 2011 Pro Motocross Credential Applicants

To: 2011 Pro Motocross Credential Applicants To: 2011 Pro Motocross Credential Applicants Welcome to AMA Pro Motocross Championship racing. Attached is the 2011 Season Credential Application packet for the Lucas Oil AMA Pro Motocross Championship,

More information

WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely

WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely 1. Name: First Last M.I. 2. Email: 2. Mailing Address:

More information

2018 BELLE CHASSE YMCA Summer Camp Registration

2018 BELLE CHASSE YMCA Summer Camp Registration Child s Name: _ Grade Entering: Pre-School (3-4 years old, must be potty trained) Member: 145/Week Non-Member: 185/Week (30/individual or 50/family one time registration fee) Youth Camp (entering grades

More information

Participant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / /

Participant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / / 2018 Denver NorthSide TTC FALL CLASSIC TOURNAMENT ENTRY FORM Sponsored by Denver Northside Table Tennis 1-Star Tournament Sanctioned by USATT with $500.00 in Cash and Trophies Saturday, October 13 th,

More information

Please fill out both sides of this form!!!

Please fill out both sides of this form!!! $ # Circle one: Mixed Doubles Rockbridge Hunt Hunter Pace & Trail Ride Please fill out both sides of this form!!! Entry fee: Adult rider (18 and over) -- $35 per horse Junior rider (under 18) -- $20 per

More information

2018 EAST JEFFERSON YMCA Summer Camp Registration

2018 EAST JEFFERSON YMCA Summer Camp Registration Child s Name: _ Grade: Please Circle One: Member Non-Member I will be signing my camper up for Youth Camp C.I.T. Youth Camp (entering grades K-6 th ) Member: 150/Week Non-Member: 190/Week (30/individual

More information

Pryme Tyme Before & After School Program Enrollment Form

Pryme Tyme Before & After School Program Enrollment Form Enrollment Form Child s Name Sex DOB / / Age Child s School Grade AM PM Both Lunch Status: E-Mail Mother s Name Cell #: Home #: Place of Employment: Work Phone: Employer s Full Address: Father s Name Cell

More information

STREET ADDRESS CITY STATE ZIP / / / /

STREET ADDRESS CITY STATE ZIP / / / / Please fill out the registration for completely and return to : YMCA of Northern Michigan 434 East Lake Street, Petoskey, MI 49770 231-348-8393 Fax 231-348-8402 Camper Information CHILD S NAME GENDER Male

More information

After School Program Registration Form

After School Program Registration Form 2018-19 After School Program Registration Form Office Use Only Date registered: _ Staff: Please fill out this form entirely. If there are blanks it may slow down your child s enrollment process. If a line

More information

Y-CLUB AFTERSCHOOL PROGRAM

Y-CLUB AFTERSCHOOL PROGRAM 2017-2018 Y-CLUB AFTERSCHOOL PROGRAM AFTERSCHOOL PROGRAM The Y-Club Program is a fun place to be after school with lots of positive staff interaction and learning opportunities. We provide a healthy afterschool

More information

Please note that there is no liability coverage for wrestling activities held at a home or residential dwelling

Please note that there is no liability coverage for wrestling activities held at a home or residential dwelling Insurance coverage 2017-18 Insurance Information At USA Wrestling, our top priorities are safety and security. That's why we make sure you're covered by General Liability, Accidental Medical Expense, and

More information

CROSSROADS YMCA MEMBERSHIP Income-based Scholarship Guidelines

CROSSROADS YMCA MEMBERSHIP Income-based Scholarship Guidelines CROSSROADS YMCA MEMBERSHIP Income-based Scholarship Guidelines If you are unable to pay the full cost of our YMCA membership, you may apply for partial assistance based on your financial situation. When

More information

First Name: Middle Initial: Last Name: Gender: D.O.B: / / Age: Years of YMCA Camp Participation: Address: Apt/Unit #:

First Name: Middle Initial: Last Name: Gender: D.O.B: / / Age: Years of YMCA Camp Participation: Address: Apt/Unit #: Camp Location: Camper Grade 2017-18 School Year: Does your camper require any special needs identified through Section 504 (I.D.E.A or an I.E.P)? Yes No If yes, please explain: Camper Grade 2018-19 School

More information

2019 WEST ST. TAMMANY YMCA Summer Camp Registration

2019 WEST ST. TAMMANY YMCA Summer Camp Registration Child s Name: _ Grade Entering 2019: Please Select One: Member Non-Member I will be signing my camper up for Pre-K Camp Youth Camp Leaders Camp Pre-K Camp (ages 3-5, must be 3 by start of session, must

More information

DAY CAMP 2018 REGISTRATION FORM

DAY CAMP 2018 REGISTRATION FORM DAY CAMP 2018 REGISTRATION FORM PARTICIPANT INFORMATION FIRST NAME M.I. LAST NAME D.O.B. GENDER Male Female PARENT / GUARDIAN INFORMATION FIRST NAME M.I. LAST NAME D.O.B. GENDER Male Female STREET ADDRESS

More information

Participant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / /

Participant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / / ENTRY FORM Sponsored by Denver Northside Table Tennis 1-Star Tournament Sanctioned by USATT with $ 300 in Cash and Prizes Saturday, March 24 th 2018 www.denvernorthsidett.com or 303-601-3415 Participant

More information

PATHFINDER WINTER CAMPOUT & SKI WEEKEND January 9-11, 2015

PATHFINDER WINTER CAMPOUT & SKI WEEKEND January 9-11, 2015 & SKI WEEKEND CLUB DIRECTOR PHONE EMAIL WE WILL BE ATTENDING THE WINTER CAMPOUT NUMBER OF STAFF X $7.00 = NUMBER OF PATHFINDERS X $7.00 = TOTAL DUE $ This is all this event will cost you, if you are camping

More information

Lake Washington Rowing Club

Lake Washington Rowing Club Lake Washington Rowing Club 2018 Junior Rowing Program Participant Information Form Participant Information (all fields must be filled out),, Last Name First Name Today s Date Mailing Address Birthdate

More information

ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION

ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION Player Information First Name: Last Name: Address: City, State, Zip: Home Phone: Email: Date Of Birth: School: Grade: Jersey Size: Age Division Select

More information

PARADE APPLICATION RULES

PARADE APPLICATION RULES PARADE APPLICATION RULES 1. All applicants for entry are subject to approval and acceptance by the Parade committee. For applications to be considered, they must be completed and received by December 1,

More information

Agreement and Release of Liability

Agreement and Release of Liability Agreement and Release of Liability MARTIAL ARTS TRAINING / WRESTLING AND FITNESS TRAINING ARE INHERENTLY DANGEROUS AND PHYSICALLY DEMANDING. IF YOU HAVE EXISTING MEDICAL CONDITIONS, BACK PROBLEMS, A HEART

More information

Release. I, do hereby:

Release. I, do hereby: , Release I, do hereby: 1. Release waive discharge and covenant not to sue Turning Point Farms, Inc. and/or Theresa Petyo, Amanda Swendseid, their operators, horse owners, investors, and each of them,

More information

Praise His Name in the Dance Psalm 149:3

Praise His Name in the Dance Psalm 149:3 Praise His Name in the Dance Psalm 149:3 Welcome to our studio! The mission of Winchester Christian Ballet, Inc. is to provide the highest quality of classical ballet training, create an atmosphere of

More information

Summit County 4-H Saddle Horse Fair Registration Return by June 1, of current year

Summit County 4-H Saddle Horse Fair Registration Return by June 1, of current year Summit County 4-H Saddle Horse Fair Registration Return by June 1, of current year Information Page Club Name: Exhibitor Name: DOB: 4-H Age (as of Jan 1) How many years in 4-H (including this year)? Parent/Guardian

More information

MEMBERSHIP APPLICATION

MEMBERSHIP APPLICATION MEMBERSHIP APPLICATION How did you hear about the Y? Which facilities/programs do you plan to use? MEMBERSHIP TYPE YOU ARE SEEKING of Application Type of Membership PRIMARY MEMBER CONTACT INFORMATION Name

More information

ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE

ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE ORDER SONS OF ITALY IN AMERICA LODGE 2662 ARTS & CRAFTS VENDOR CONTRACT/RELEASE DATE: JUNE 22 & 23, 2019 OCTOBER 5 & 6, 2019 LOCATION: THE MARKET COMMONS TIME: JUNE SATURDAY 11 AM 8 PM / SUNDAY 11 PM 7

More information

Structural Rigging Information

Structural Rigging Information Structural Rigging Information General Information Freeman Audio Visual is the exclusive structural rigging contractor for the George R. Brown Convention Center. During the initial design stages, please

More information

TEEN LEADERSHIP DEVELOPMENT REGISTRATION FORM

TEEN LEADERSHIP DEVELOPMENT REGISTRATION FORM TEEN LEADERSHIP DEVELOPMENT REGISTRATION FORM 2017-2018 Teen First Name Last Name Please select the program(s) that you are wanting to register for the 2017-2018 school year and include your deposit(s)

More information

CAMPER IN LEADERSHIP TRAINING (CILT) REGISTRATION

CAMPER IN LEADERSHIP TRAINING (CILT) REGISTRATION CAMPER IN LEADERSHIP TRAINING (CILT) REGISTRATION Please circle the CILT program that you are interested in applying for: *Downtown *Camp Thunderbird *Chester *Chickahominy *Goochland *Midlothian *Northside

More information

Information about membership -

Information about membership - MEMBERSHIP INFORMATION 2018 We are excited about ST. CROIX JOAD and the opportunities that will present themselves to youth archers ages 8-20. ST. CROIX JOAD is one of only a handful USA ARCHERY JOAD clubs

More information

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF.

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF. Dear Race Director, Thank you for your interest in using the USECF event coverage for your event. Enclosed you will find USECF insurance information for the 2017 year which can be used for gravel grinders,

More information

Metzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly

Metzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly Metzlers Gymnastics Training Center NON-COMPETE TEAM REGISTRATION FORM Please Print Clearly Last Name: Parent s Name: Address: City: State: Zip Code: Home Phone: Cell Phone: E-mail address: Work Phone:

More information

Chamber Bed Race Rules & Release of Liability/Registration Form

Chamber Bed Race Rules & Release of Liability/Registration Form Chamber Bed Race Rules & Release of Liability/Registration Form Bed Design Beds must measure at least 3 feet wide by 6 feet long, but no more than 6 feet wide by 8 feet long handles included. (This means

More information

ANNUAL LAKE ERIE OPEN WATER CLASSIC

ANNUAL LAKE ERIE OPEN WATER CLASSIC Sunday, July 19, 2015 Sanction Number: EVENT INFORMATION EVENTS: There will be ½-Mile, 1-mile and 2-mile swims on a triangular course in Lake Erie. The start will be in the water. The finish will be on

More information

APPLICATION FOR PART TIME EMPLOYMENT

APPLICATION FOR PART TIME EMPLOYMENT APPLICATION FOR PART TIME EMPLOYMENT Position: Desired Hourly Rate: Last Name First Name Date Address Street City State Zip Code Phone Number Email Address Are you at least 18 years of age or older? Yes

More information

REGISTRATION FORM WAIVER. E-M AIL ADDRESS: Driver License # DATE OF BIRTH: AGE AS OF DEC. 31, 2018: ADULT T-SHIRT SIZE (S - XXXL):

REGISTRATION FORM WAIVER. E-M AIL ADDRESS: Driver License # DATE OF BIRTH: AGE AS OF DEC. 31, 2018: ADULT T-SHIRT SIZE (S - XXXL): REGISTRATION FORM NAME: GENDER: E-M AIL ADDRESS: Driver License # DATE OF BIRTH: AGE AS OF DEC. 31, 2018: ADULT T-SHIRT SIZE (S - XXXL): MAILING ADDRESS: CITY: STATE: ZIP CODE: PRIMARY PHONE: EMERGENCY

More information

Ella Sharp Park, 3225 Fourth Street, Jackson, MI 49203

Ella Sharp Park, 3225 Fourth Street, Jackson, MI 49203 July 18 and 19 2014 Arts/Crafts, Non-Profit Merchandise, Commercial Vendor Application Ella Sharp Park, 3225 Fourth Street, Jackson, MI 49203 Business Name Contact Person Address City State Zip Telephone

More information

RETAIN THIS SHEET FOR YOUR INFORMATION AND MAIL ENTRY FORM

RETAIN THIS SHEET FOR YOUR INFORMATION AND MAIL ENTRY FORM REVISED 01/20/08 SIXTH ANNUAL AAU TRIPLE CROWN CLASSIC 2008AAU EAST COAST BENCH PRESS CLASSIC 2008 AAU MILITARY NATIONALS FULL POWER 2008 AAU MILITARY NATIONALS BENCH PRESS ENTRY DEADLINE: APRIL 20, 2008

More information

For office use only: Agency Participant. T-shirt received Shirt size: Adult- M L XL

For office use only: Agency Participant. T-shirt received Shirt size: Adult- M L XL SUMME ER DAY CAMP WEINGART-LAKEWOOD FAMILY YMCA REG GISTRA ATION PACKE ET For office use only: Agency Participant Year Round Participant T-shirt received Shirt size: Youth- XS S M L Adult- S M L XL SUMMER

More information

A.A.U. Region 9 Taekwondo Championship March 2, 2013 Butler Sports Complex South Main Houston, Texas INFORMATION SHEET

A.A.U. Region 9 Taekwondo Championship March 2, 2013 Butler Sports Complex South Main Houston, Texas INFORMATION SHEET INFORMATION SHEET Competition Date: SATURDAY, MARCH 2, 2013 Entry Fees: 1 or 2 Individual Events $85.00 3 Events $100.00 CLINICS: Referee Clinic ONLY: $35.00 (coaches must take clinic online!) Friday,

More information

Pocock Rowing Center

Pocock Rowing Center Pocock Rowing Center Office Use QB LGL XL S Code Membership Forms New Member Existing Member Former Member First Name: Last Name: Address: City: St: Zip: Email Address: Cell Phone ( ) Alt Phone: ( ) Gender:

More information

Karen McCallum. Volunteer- Counselor in Training Applications. Spring Dear Counselor in Training Applicant:

Karen McCallum. Volunteer- Counselor in Training Applications. Spring Dear Counselor in Training Applicant: Volunteer- Counselor in Training Applications Spring 2018 Dear Counselor in Training Applicant: Boardman Park Adventure Day Camp Program prides itself on its reputation for quality and service. This recognition

More information

2012 AAU SOUTHWEST DISTRICT QUALIFIER

2012 AAU SOUTHWEST DISTRICT QUALIFIER INFORMATION SHEET Competition Date: SATURDAY, FEBRUARY 11, 2012 Entry Fees: 1 or 2 Individual Events $65.00 3 Events $75.00 CLINICS: Referee Clinic ONLY: $35.00 (coaches must take clinic online!) Friday,

More information

$35/Stall/Night Stabling/ Haul in Fee Haul in fee will be charged to those who do not have a Galway Downs

$35/Stall/Night Stabling/ Haul in Fee Haul in fee will be charged to those who do not have a Galway Downs Entries will not be accepted without payment. Close date is the second Friday before the event. Late entries accepted until the Wednesday before the event. Scratches must be in writing to DelMarEventing@gmail.com.

More information