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Wood Chop Entry Form
Name
*
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
*
Email
*
Class & Nomination Fee
1. 280mm S/B Handicap - $15
2. 280mm U/H Handicap - $15
3. 300mm S/B Handicap - $15
4. 325mm U/H Handicap - $15
5. Novice Chop 280mm U/H Handicap - $10
6. 280mm Tree Felling Handicap - $15
7. 280mm U/H Handicap Veteran - $15
8. Combination Relay - $7.50 / person
9. 300mm A Grade S/B Championship - $15
10. 280mm B Grade S/B Championship - $15
11. 280mm C Grade S/B Championship - $15
12. Junior Chop, Under 15 Years - No Entry Fee
13. 280mm Parent & Child Relay - $7.50 / person
14. 250mm S/B Handicap - $15
15. Ladies 280mm U/H Handicap - $15
Terms & Conditions
*
I hereby authorize the entry herein described & agree to be bound by the Rules & Regulations of the Pioneer Valley Show Society
In this Waiver, Release and Acknowledgement Form “The Pioneer Valley Agricultural Show Society” means and includes all affiliated entities; servants or agents of the Society, all employees of the Society, all members of the Society and all Volunteers of the Society and/or all affiliated entities.
Waiver, Release and Acknowledgement
*
I acknowledge that I have read this waiver fully and understand it's terms and that I have give up substantial rights signing it.
I have agreed to these freely and voluntarily without any inducement made to me and intent this to be a complete and unconditional release of all liability to the greatest extent allowed by law.
By participating in the Event:
1. I acknowledge that it is a condition of participating in the Event that I do so at my own risk. I accept all risks and release the Society from all claims, demands and proceedings arising out of or connected with my participation in the Event and indemnify them against all liability for any injury, loss or damage arising out of or connected with my participation in the event. This release continues forever and binds all of my heirs, successors, executors, personal representatives and assigns.
2. I acknowledge that it is a condition of participating in the Event that the Society and any person or body directly or indirectly associated with the Event are absolved from all liability arising for injury or damage to myself or my property howsoever caused arising out of my participation in the Event whatsoever whether due to any negligent act, breach of duty, default and/or omission on the part of the Society and any person or body directly or indirectly associated with the Event, or otherwise.
3. I acknowledge that participating in the Event may involve a risk of serious injury or even death. I accept all risks necessarily flowing from participating in the Event.
4. I acknowledge that the Society relies on the information provided by me and state that all such information is accurate and complete.
5. I warrant that I am physically fit to participate in the Event and that I have not been advised otherwise by a qualified medical practitioner. I acknowledge that I must disclose any pre-existing medical or other condition that may affect the risk that either myself, or any other person will suffer injury, loss or damage.
6. I consent to receiving any medical treatment including ambulance transportation that the Society and any person or body directly associated with the Event think desirable as required during the event.
7. I acknowledge that it is a condition of participating in the Event that I follow the instructions of the Society and any person or body directly or indirectly associated with the Event at all times. I indemnify and keep indemnified the Society and any person or body directly or indirectly associated with the Event from all claims, demands and proceedings arising out of or connected with a failure by me to comply with rules and/or directions given to me by the Society and any person or body directly or indirectly associated with the Event.
Declaration of Minors - Under 18 Years of Age
If you are under the age of 18 years on the Event Day your parent/guardian must approve this declaration.
Minors Full Name
Minors Date of Birth
DD
/
MM
/
YYYY
Parent/Guardian Full Name
I certify that I am the parent/guardian of this minor and that he/she has trained for and has my consent to participate in the Event.
I testify that I have read the above and acknowledge acceptance of the stated conditions on behalf of the minor specified above.
In consideration of the facilities provided to us, I myself, my executors, administrators and assigns and for the child/children/under age persons/s (if applicable) absolutely release and discharge the Pioneer Valley Show Society and any person directly or indirectly associated with the Event from all claims, demands and proceedings arising out of or connected with participation in the Event that I or the child/children/underage person/s may suffer or sustain.
Online nominations will not be accepted until entry fees have been received.
Pioneer Valley Agricultural Show
BSB: 064707
A/C Number: 00919932
Ref: Surname and section e.g. Smith, Craft
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