January 9, 2019 by Teresa ALS Benefit Registration Individual A few words about what the benefit link is… ALS Benefit for Pescadero Individual Registration July 2019 Name First Last Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country PhoneGender*MaleFemaleBirthdate* Dog's NameCompetitors without dogs can leave this blankDog's Birthdate Dog's Height in inchesDog's BreedCourse Length* 6 mile 3 mile 1 mile Waiver and Hold Harmless AgreementIn consideration of permission granted by K9 Gladiators and Steven and Jessica Cloug, Montana K9 Sports, LLC allowing me to participate in the Mud and Obstacle Course and/or Extreme Recall (the "Activity"), which will occur on August 11-12, 2018, I (together with my parent or guardian, if I am under the age of eighteen (18) or under a legal disability) represent, covenant and agree, on behalf of myself and my heirs, assigns, and any other person claiming by, under or through me, as follows: 1. I acknowledge that participating in the Activity involves certain risks (some of which I may not fully appreciate) including, but not limited to: sprains; strains; fractures; heat and cold injuries, heat-related illness and hypothermia; injuries involving the acts of other Event participants or vehicles; animal bites and/or stings; contact with poisonous plants; heart attack; diseases from exposure to fecal contaminated water or mud; permanent paralysis and that injuries, death, property damage or other harm could occur to me, my dog or others. I accept and voluntarily incur all risks of any injuries, damages, or harm which arise during or result from my participation in the Activity, including any associated travel, regardless of whether or not caused in whole or in part by the negligence or other fault of K9 Gladiators, trustees, affiliates, employees, officers, agents or insurers ("Released Parties"). 2. I waive all claims against any of the Released Parties for any injuries, damages, losses or claims, whether known and unknown, which arise during or result from my participation in the Activity, regardless of whether or not caused in whole or part by the negligence or other fault of any of the Released Parties. I release and forever discharge the Released Parties from all such claims. 3. I agree to indemnify and hold the Released Parties harmless from all losses, liabilities, damages, costs or expenses (including but not limited to reasonable attorneys' fees and other litigation costs and expenses) incurred by any of the Released Parties as a result of any claims or suits that I (or anyone claiming by, under or through me) may bring against any of the Released Parties to recover any losses, liabilities, costs, damages, or expenses which arise during or result from my participation in the Activity, regardless of whether or not caused in whole or part by the negligence or other fault of any of the Released Parties. 4. The insurance fee below is liability only and not personal medical insurance and is in no way a replacement for or supplement to your personal health insurance plan should you sustain any injury while participating in the race or while on the property.Acknowledgement* I agree to terms and insurance By checking the agree box, you are agreeing with the terms of the Hold Harmless Agreement above and agree to the $7 insurance charge.Acknowledgement* I agree to terms and insurance By checking the agree box, you are agreeing with the terms of the Hold Harmless Agreement above and agree to the $7 insurance charge.Acknowledgement* I agree to terms and insurance By checking the agree box, you are agreeing with the terms of the Hold Harmless Agreement above and agree to the $7 insurance charge.Early Early Price Deadline dateEarly Price Deadline dateRegular Deadline dateT-shirt deadline dateEarly Early Registration*Individual $85.00Youth $65.00Early Registration*Individual $95.00Youth $75.00Registration*Individual $105.00Youth $85.00T-shirt sizePlease select sizeSMLXLXXLXXXLLimited availability so sign up early.Event t-shirt Price: $0.00 Overnight Camping Charge Price: $25.00 Quantity: Total $0.00 The submit button will take you to PayPal where you can either pay with your PayPal account or a credit card.