AADS PL ExtraLarge - WORKING copy.indd - All-American Dairy ...

ALL-AMERICAN DAIRY SHOW
YOUTH / OPEN
PENNSYLVANIA FARM SHOW COMPLEX & EXPO CENTER | 2300 N. CAMERON STREET, HARRISBURG, PA 17110-9443
* * * ONLY LIST ONE OWNER ON THIS FORM * * *
Farm Name: __________________________________________________________________________________________
Exhibitor (must be owner): _______________________________________________________________________________
Address: _____________________________________________________________________________________________
City: ________________________________________ State: _____________________Zip Code: ____________________
PA County: ___________________________________ Telephone Number: ______________________________________
E-mail: ______________________________________________________________________________________________
SS# or Fed ID # (Required to receive Premiums): _______________________________________________________________
Junior Exhibitor Birthdate: _____________________ Junior Exhibitor Shirt Size (Adult S-XXL): ___________________
Is this a “Family Unit” Entry? Yes o or No o If yes, are you the Primary o or Member o
(If the “Family Unit” option is selected, an animal owned by any person in the group may be substituted for one owned by any other person in the group according to substitution
rule 20 in the premium list)
List Member Names & Relationships: ____________________________________________________________________
_____________________________________________________________________________________________________
This entry constitutes an agreement by, a certification, and a warranty of the entrant, and those he or she represents, that he/she and each has read, fully
understands and accepts all rules and regulations of the All-American Dairy Show including without limitation the P.D.C.A. Code of Ethics and will comply with
them. The entrant further agrees and those he/she represents agree that, if this entry is accepted by All-American Dairy Show each such person or enterprise
and their principals and agents acknowledge and agree that they and each of them (1) are bound by and will act in accordance with the rules and regulations
of All-American Dairy Show and the P.D.C.A. Code of Ethics in all shows; including the enforcement procedures; (2) will accept the final decision of the Show
Manager of All-American Dairy Show and/or Board of Directors of PA Dairy & Allied Industries Association, Inc. on any question arising under said rules and
regulations; and (3) agree to hold All-American Dairy Show, the PA Dairy & Allied Industries Association, Inc., The Pennsylvania Farm Show Commission, the
Commonwealth of Pennsylvania and Pennsylvania Department of Agriculture and its officials, directors, officers, employees, representatives and agents harmless
for any action taken under said rules and regulations; and will hold All-American Dairy Show, the PA Dairy & Allied Industries Association, Inc., and their
directors, officers, officials, employees, agents and volunteers harmless from and against any injury, damage or loss suffered during or in connection with the
show, whether or not such injury or loss resulted from or was contributed to by, directly or indirectly, the acts or Commissions of PA Dairy & Allied Industries
Association, Inc. or All-American Dairy Show officials, agents, employees, directors, officers, volunteers, representatives or agents. I certify by signing this entry
that (1) the entry information is true and correct; (2) I have the authority to make this AGREEMENT, CERTIFICATION AND WAIVER, and to bind all persons
and enterprises with any interest in the entered animal(s) to the terms of this AGREEMENT, CERTIFICATION AND WAIVER, and do so bind them, their heirs,
assigns or successors; (3) I, on my own behalf, and/or behalf of all other persons and enterprises having any interest in the entered animal(s) together with
my, our and/or their heirs, assigns and successors are bound by the provisions of this entry, and this AGREEMENT, CERTIFICATION AND WAIVER; (4) I and all
other persons and enterprises with an interest in the entered animal(s) accept full responsibility for my actions, and for those of anyone else, including but not
limited to fitters, who are involved in the care of, show preparation and/or showing of the entered animal(s); and (5) I have established a Veterinarian-Client-
Patient Relationship for the animal(s) entered and exhibited.
I HAVE READ AND AGREE TO THE ABOVE.
__________________________________ ________________________________ ______/_______/_______
Signature, Owner or Authorized Agent Print or Type Name Date
8/20/11 9/1/11
FEE TABLE
BY
24
TO TO HOURS
(per animal) 8/19/11
8/31/11 9/18/11
BEFORE
Youth Show Only $30.00 $40.00 $55.00 ------------
Youth Show & Open show $40.00 $50.00 $125.00 ------------
Open Show Only $30.00 $40.00 $125.00 $225.00
Number of Animals Entered:
Number of Extra Stalls ($30.00 ea):
Total Fees (This form only):
Make checks payable to “AADS”
____________
____________
$ ___________
CREDIT CARD INFORMATION
VISA MASTERCARD DISCOVER
Card Holders Name: ____________________________________________
Card #: _______________________________________________________
CVV2#: _______________Exp. Date: ______________Zip Code: _______
Signature: _____________________________________________________
SPECIAL INSTRUCTIONS:
1. INDIVIDUAL ANIMALS - fill in all spaces for each animal. Ear tag and/
or tattoo must be listed.
2. PRODUCTION RECORDS - An official (DHI-DHIR) actual 2X, 305
days or less record should be listed on each lactating animal Junior 3 yr.
old and older. Entries without production records will be marked "No
305D record with entry".
3. GROUP ENTRIES - Get of Sire: Identify Sire ONLY on line for name
of "Sire". Produce of Dam: Identify Dam ONLY on line for name of
"Dam". Dam and Daughter: Identify Daughter on line for "Name of
Animal" and identify dam on line for name of "Dam".
4. ENTRY FORMS - must be signed by owner or authorized agent.
5. STALLING - Include any special requests for stabling
ANY ADDITIONAL REQUESTS MUST BE RECEIVED BY 4:00 P.M.
FRIDAY, SEPTEMBER 3
LARGE GROUPS - INDICATE TAIL TO TAIL OR IN LINE.
STALLING REQUESTS:
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