NCJLS Entry Form - Nueces County Junior Livestock Show

Entry Deadline
5:00 PM- TO CLUB/CHAPTER
82nd Annual Nueces County
Junior Livestock Show ENTRY FORM
NEW
LEADER
Friday - October 21, 2016
Show Dates - January 9, 13 - 21, 2017
1. EXHIBITOR INFORMATION—(Please Type or Print)
Quality Counts # ________________________
Exhibitor Legal Name:
First: _________________________ Middle: _________________ Last: __________________________ Soc. Sec. #: __________________
Exhibitor Address: ____________________________ City: _______________________ Zip:_________ Phone: (361) _________________
(Mailing address)
E-mail Address: ________________________ School: _____________________________ Grade:_________ DOB: ___________________
(required)
Check
Each
Division
Entered
Division
Homemaking Sweepstakes Participant (must be 9 - 12 grade)
Number
Entered
Market Projects (*Exhibit ONLY 1)
Market Steer
1
Market Lamb
1
Market Swine
1
Fee
$20.00
$20.00
$20.00
Market Rabbit
(Pen of 3)
1
$20.00
Broiler (Pen of 3)
1
$20.00
Turkey
Meat Goat
Carcass Steer
1
1
$20.00
$20.00
Carcass Steer
Breeding Show
1
$20.00
Breeding Beef Female
$20.00/hd
(attach copy of Reg Papers if
applicable)
Breeding Sheep
Breeding Rabbit
Fryer Rabbit (Limit 2)
Single Fryer Rabbit
Horse ($5.00 per Exhibitor )
Horse Validation (attach Proof of Ownership
for each Horse on Validation Form)
Amount
Due
AGREEMENT TO ARBITRATE
$0.00
$20.00/hd
$4.00/hd
$0.00
$0.00
$4.00/hd
$0.00
$5.00
# Passes
Arts & Crafts/MAX 10
$4.00/each
Clothing/MAX 10
$4.00/each
$0.00
$0.00
Creative Stitchery
/Max 10
$4.00/each
$0.00
Foods/Max 10
$4.00/each
$0.00
$0.00
Photography/MAX 10
$4.00/each
Ag Mech & Handicrafts - Limit Junior 2 & Senior 3 each
Shop
Passes
Car Pass
TOTAL SHOW FEES
ALL ENTRY FORMS WILL ONLY BE ACCEPTED AT THE
SHOW OFFICE FROM AST/FCCLA LEADERS OR CLUB
MANAGERS.
MUST BE AN OFFICIAL MEMBER OF 4-H, FCCLA or FFA TO
BE EILGIBLE TO PARTICIPATE
Social Security Numbers are required on ALL entries.
All entries MUST be signed and notarized.
Show Office Information:
Mailing address: NCJ LS; P O Box 260968; Cor pus Chr isti, TX 78426
Physical address: 710 East Main; Robstown, TX 78380
Phone: 361-387-5395 FAX 361-387-4295
Website: www.ncjls.com
Homemaking - $4.00 per entry
# Entered
IMPORTANT INSTRUCTIONS:
$20.00/each
$0.00
$15.00/each
Total Show Fees
$0.00
$0.00
Receipt:
Paid: ___________ cash/check Check # __________ Date: _______
IMPORTANT:
My Nueces County Jr Livestock ANIMAL project will be raised at:
________________________________________________________
STATEMENT CONCERNING ALTERNATIVE DISPUTE RESOLUTION
FOR EXHIBITORS IN THE N.C.J.L.S.
I am aware that it is the policy of the State of Texas to promote the amicable and nonjudicial settlement of disputes. I am aware of alternative dispute resolution methods including arbitration and mediation which are
contained in the Texas Civil Practice and Remedies Code Title 7. I agree
to mediate and or arbitrate any dispute that I or my child (Exhibitor) has or
may have with the Nueces County Junior Livestock Show, (Hereinafter
referred to as NCJLS)
While I recognize that alternative dispute resolution is an alternative to and
not a substitute for a trial and that usually a case involving controversy
may be tried if it is not settled, I represent and covenant to the NCJLS that
as part of the consideration for allowing my child to participate in the
NCJLS I will pay the prescribed or applicable fee and submit any claim or
dispute to the Executive Board or Board of Directors of the NCJLS within
24 hours of the action or inaction giving rise to the dispute but in no event
(whether within 24 hours or not) after the commencement of the Blue Ribbon Sale on Saturday morning.
I also herein state and affirm that any claim or dispute that I may have or
my child may have as an exhibitor which is not resolved to my satisfaction
by the NCJLS Executive Board or Board of Directors. I agree to refer to
alternative dispute resolution without necessity of court intervention. I
waive my right to a court trial or any judicial proceeding, and agree to submit to mediation with a mutually agreeable mediator any dispute I may
have or my child may have with the NCJLS. I further agree to pay one half
(½) of the mediators fee to the mediator in advance of the mediation. If
mediation is unsuccessful in resolving my conflict or the conflict of my child
with the NCJLS then I will submit my claim/contest to binding arbitration
with a mutually agreeable arbitrator. Failing to agree upon a mutually
agreeable mediator or arbitrator, the parties will ask that the presiding
Administrative Judge of Nueces County (as a disinterested party only and
not in his or her official capacity) appoint one for the parties.
MUST BE NOTARIZED ON BACK CERTIFYING
YOU HAVE READ AND UNDERSTAND THE
AGREEMENT TO ARBITRATE
PART I
RELEASE OF LIABILITY AND INDEMNITY AGREEMENT— ( all exhibitors & parents must sign before a notary )
In consideration, the receipt and sufficiency of which is hereby acknowledged, for being allowed entry into and participation in activities (the “Activities”) associated with the Nueces County Junior Livestock
Show Association (NCJLS), the undersigned hereby enter into this RELEASE OF LIABILITY AND INDEMNITY AGREEMENT (this “Agreement) as of the date set forth below.
1. ACKNOWLEDGMENT OF RISKS: The undersigned recognizes and understands that there are risks associated with their participation in the Activities includi ng, but not limited to, bodily
injury or death to persons and damage to property. The undersigned further acknowledges and understands that they will be held liable and responsible for any and all damage to persons, livestock, vehicles,
property and/or improvements to property that is caused by them and/or any persons (including, but not limited to, minors) under their care and control, and that arise out of, or are related to, the undersigned’s entry into and participation in the Activities.
2. APPLICABILITY AND SCOPE OF RELEASES AND INDEMNITIES: For purposes of this Agreement, “Claims” shall mean any past, present and future claims, losses, costs, expenses, liabilities, demands, or causes of action, and costs of defense or settlement (including, without limitation, attorneys’ fees and court costs). The releases, waivers and indemnities contained in this Agreement expressly
shall apply regardless of whether the Claims to be released, waived or indemnified against arise, or are alleged to arise from (i) NEGLIGENCE (WHETHER SOLE, JOINT OR CONCURRENT), GROSS
NEGLIGENCE, NEGLIGENCE PER SE, and/or STRICT LIABILITY, of NCJLS, the County of Nueces, and the Nueces County Showbarn Trustees, or their respective present and former officers,
directors, members, subsidiaries, affiliates, employees, staff and agents, and any other person, firm or corporation bound to defend or pay judgments against them (the “Released Parties”); (ii) personal injury,
death or property damage; (iii) acts under the Texas Deceptive Trade Practices Act (“DTPA”); (iv) acts of any other persons or guests; (v) theft, burglary, assault, or other crimes; (vi) fire, water, wind, rain and/
or smoke and/or (vii) any other risks and hazards associated with the undersigned’s entry into and participation in the Activities, including, but not limited to, the general conditions at the Activities, animals
both wild and domestic that may be diseased and/or potentially dangerous, persons with firearms both on and off the premises used in connection with the Activities, and the driving or riding in any vehicles,
whether belonging to Released Parties or to other persons.
3. RELEASE FROM LIABILITY: The undersigned hereby RELEASES, ACQUITS AND FOREVER DISCHARGES, and WAIVES any and all Claims against any of the Released Parties that arise from
or relate to their entry and participation in the Activities – including, but not limited to, the types of Claims enumerated in Paragraph 2 – and agree not to sue any of the Released parties for such Claims.
Without limiting the foregoing, the undersigned agrees that the Released Parties shall not be liable to them, their family, or their guests, for personal injury, property damage, or any other Claims arising from
or related to the undersigned’s entry into and participation in the Activities. As further inducement to NCJLS to permit the undersigned’s entry into and participation in the Activities, the undersigned represents
that they thoroughly and completely understand that this is a complete and final release and indemnity agreement, that they are freely and voluntarily entering into this Agreement, and that no representations,
promises or statements made by an Released Party, or any agent, attorney or other representative or any Released Party has influenced the undersigned in causing them to sign this Agreement.
4. AGREEMENT TO INDEMNIFY AND HOLD HARMLESS: The undersigned agrees to INDEMNIFY, DEFEND, PROTECT, and HOLD HARMLESS NCJLS and all of it ’s parents, subsidiaries, affiliates,
officers, directors, committee members, volunteers, partners, employees, sponsors, attorneys, insurers, and agents (collectively, “NCJLS” Indemnities) from any of the following: loss, damage, claims, suits,
taxes, liens, penalties, fines, liabilities, and expenses (including attorney fees) arising out of , or relating to, directly or indirectly this contract. Undersigned shall indemnify, defend, protect, and hold harmless
the NCJLS Indemnities from any and all claims, suits, taxes, liens, penalties, fines, liabilities, and expenses (including attorney fees) from any agent, employee, assignee, subcontractor, or servant of provider.
Indemnification of the NCJLS Indemnities includes, but is not limited to, any claims for injuries or death to persons or damages to or destruction of property, claims and liens for storage, labor, and materials
and all loss of and damage to equipment. This Indemnification is expressly intended to require provider to indemnify and completely the NCJLS Indemnities, including full indemnity for all liability incurred as a
result of the sole, concurrent, or contributory liability of the NCJLS Indemnities, if any.
5. PHOTOGRAPH/INTERVIEW RELEASE AND INDEMNITY AGREEMENT: The undersigned GRANTS PERMISSION to be PHOTOGRAPHED or INTERVIEWED in connection with the Activities.
The undersigned understands that any such photograph or interview may be used by the Released Parties or television, film, vi deo, visual, graphic or printed media. The undersigned agrees to RELEASE
and INDEMNIFY the Released Parties with respect to any Claims related to the usage of such photographs or interviews by the Released Parties or any media – including, but not limited to, the types of
Claims enumerated in Paragraph 2.
6. Do NOT sign this entry if you have not read the rules as published in the Nueces County Jr Livestock Show Rule Book/ Horse Show Rule supplement. By signing this entry form, I certify that
my club/AST/FCCLA leader has supplied me with the Nueces County Junior Livestock Show Rule Book/ Horse Show Supplement and I have read, understand and agree to abide by all rules in the current
Rule Book.
PART II
Drug Certification Form - (all market exhibitors & parents must sign)
We, the junior exhibitor and parent/guardian certify that we have read, understand and will abide by all rules and regulations of the Nueces County Junior Livestock Show. We further certify
that we have not administered to and have no knowledge that this entry has received any substance not approved by the Food and Drug Administration (FDA) and/or the U.S. Department of
Agriculture (USDA) for food animals.
This entry is not, nor will it be, within any withdrawal time relative to the administration of any drug, chemical or feed additive approved by the FDA and/or the USDA by the time the animal(s) is
officially weighed in by the Show. Exception: If any animal needs emergency treatment before weigh-in, the animal may be treated by the official show veterinarian or under his supervision,
provided an NCJLS official collects a urine sample from the animal before any medical treatment is administered.
If an animal requires emergency treatment while on show grounds, only a licensed veterinarian will be allowed to administer any drug, chemical or feed additive. A NCJLS Executive Committee member must be notified in advance and he/she must be present. All treatment costs are the responsibility of the exhibitor. If an animal is treated by a licensed veterinarian while at the
Show and the medication administered exceeds 15 days withdrawal time, the animal(s) will be disqualified and not allowed to be shown. If the disqualified animals is a market steer, market
lamb, poultry project, market swine, market rabbit or market goat, the animal must be immediately removed from the Show grounds by the exhibitor. Should a placing animal(s) receive treatment requiring a 15 day or less withdrawal period, the Nueces County Junior Livestock Show will feed the animal for the duration of the withdrawal period with a charge to the exhibitor for the
feed. The undersigned hereby releases the NCJLS from any damages which might arise out of such a feeding.
We also certify that we have read the information contained in the Nueces County Junior Livestock Show catalog. The Nueces County Junior Livestock Show reserves the right to condemn
and/or disqualify any animal, either live or slaughtered, found in violation of the use of drugs, chemicals, or feed additives as described above and the exhibitor will forfeit, as a minimum penalty, the resale value of the animal, and may be barred from any or all future competitions in the Nueces County Junior Livestock Show. If any animal is disqualified for testing positive and/or the
carcass condemned at the slaughter, the class placing will not change.
PART III
SUBSTITUTE FORM W-9:
Certification: Under penalties of perjury, I certify that:
1)
The number shown on this form is my correct taxpayer identification number,
2)
I am a U.S. Citizen, and
3)
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am
subject to backup withholding as a result of a failure to report all interests or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
You may cross out item (b) above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax
return.
The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid backup withholding.
By signing this entry form, I certify that I have read, understand and agree to abide by all the rules in the current NCJLS Rule Book, NCJLS Horse Show Rules and Agreements set forth herein:
____________________________________________________________________________________________________________________________________________________________
Exhibitor Signature
Date
Printed Name
____________________________________________________________________________________________________________________________________________________________
Parent/Legal Guardian’s Signature
Date
Printed Parent/Legal Guardian
Sworn to and subscribed before me this __________ day of _____________, 20 ____
______________________________________________________________________
Notary Public
I certify that this entry is eligible in accordance with the rules of the current NCJLS Rule Book and I have informed the owner of the consequences of stated rule violations of the use of drugs,
chemicals and/or feed additives. To the best of my knowledge, the certification is correct.
Club Manager/AST/FCCLA Signature: ___________________________________________________________________________________________________________________________