Official American Kennel Club Entry Form

German Shepherd Dog Club of America, INC Agility Trial  #2004009301

October 13th / 14th 2004

 o Wed Oct 13th     Standard                                          o Wed Oct 13th  JWW

 o Thur Oct 14th     Standard                                          o Thur Oct 14th JWW

 

ENTRY FEE:  (Including $3.00 AKC recording fee)  is $35.00 for each dog entered in first run and $10.00 for same dog entered in second run.  Entries open Aug 11th   at12 PM and close Sept  22nd, 2004 at 6:00 PM. Make checks payable to GSDCA in US Funds, and mail to:

Robin Cohen, 16820 226th Avenue NE, Woodinville, WA 98077. Canadian exhibitors must make funds payable in U.S. Funds. I enclose $________for entry fees. 

 Important -- Read carefully instructions on Reverse Side Before Filling Out. Numbers in the boxes indicate sections of the instructions relevant to the information needed in that box  (PLEASE PRINT LEGIBLY)

Breed                                     Variety(1)                      Sex  M  F             Height at Withers:

German Shepherd Dog

Standard Agility Trial Class  Jumps with Weaves                                 Jump Height Division      

NA  NB OP  EXA  EXB         NA  NB  OP  EXA  EXB                   8”    12”    16”    20”    24”

 Preferred  Trial Class        Preferred JWW Class                             Jump Height Division      

Novice  OP  EXA  EXB       Novice   OP  EXA  EXB                      4”      8”    12”    16”    20”

AKC Registered Name (Include AKC Titles Only)                      Call Name

 

o AKC Reg. No.                                                         Date of Birth: _________________

oAKC Litter No.                                                         Place: o USA   o CAN    o Foreign

o ILP No.

o Foreign Reg. No.

Breeder

Sire

Dam

Actual Owner(s) Please Print

 

Owners Address

 

City                                              State                            Zip

Handler: (Jr. Handler See Back)

                                                                                               Fee Enclosed: $________         

I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered above.  In consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of the American Kennel Club in effect at the time of this show or obedience trial or agility match and further agree to be bound by the agreement printed on the reverse side of this entry form.  I (we) certify and represent that the dog entered is not a hazard to persons or other dogs.  This entry is submitted for acceptance on the foregoing representation and agreement.

 

Signature of owner or his agent duly authorized to make this entry   Area Code  & Phone

X______________________________________________________(___)_______________

Parent or Guardian Signature if Owner is Under 18    E-Mail Address:___________________

___________________________________________________________________________

 

o  I have a Height card for this and  I have attached a copy to the entry form

 

 Single copies if the latest editions of the “Rules Applying to and Dog Shows” and “Obedience Regulations” and “Regulations for Agility Trials” may be obtained WITHOUT CHARGE from The American Kennel Club, 5580 Centerview Drive, Raleigh, North Carolina  27606-3390.

 AGREEMENT

 I (we) acknowledge that the “Rules Applying to Dog Shows” and if this entry is for an Agility Trial, the “Regulations for Agility Trials” has been made available to Me (us), and that I am (we are) familiar with their contents.  I (we) waive any and all claims and causes of action that I (we) might otherwise have against the AKC and any AKC approved judge judging at this show, under AKC rules, regulations, and guidelines.  I (we) agree that the club holding this Agility Trial has the right to refuse this entry for cause, which the club shall deem to be sufficient.  In consideration of the acceptance of this entry and of the holding of the Agility Trial and of the opportunity to have the dog judged and to win prize money, ribbons, or trophies, I (we) agree to hold this club, its members, directors, governors, officers, agents, superintendents or show secretary and the owner or lessor of the premises and any employees of the aforementioned parties, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or upon the agility trial premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss of this dog by disappearance, theft, death, or otherwise, and from any claim for damage or injury to the dog, whether such loss, disappearance, theft, damage, or injury be caused by the negligence of the club or any of the parties aforementioned, or by the negligence of any other person, or any other cause or causes.

 

I (we) hereby assume the sole responsibility for and agree to indemnify and save the aforementioned parties harmless from any and all lose and expenses (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person including myself (ourselves) on or account of damage to property, arising our of or in consequence of my (our) participation in this Agility Trial, howsoever such injuries, death of damage to property may be caused, and whether or not the same may have been caused or may have been alleged to have been caused by negligence of the aforementioned parties or any of their employees or agents, or any other persons.

 INSTRUCTIONS

 1.  (Variety) if you are entering a dog of a breed in which there are varieties for show purposes, please designate the particular variety you are entering i.e., Cocker Spaniel (solid color black, ASCOB, parti-color); Beagles (not exceeding 13 in. over 15 in.); Dachshunds (longhaired, smooth, wire-haired); Bull Terriers (colored, white); Manchester Terriers (standard, toy); Chihuahuas (smooth coat, long coat); Poodles (toy, miniature, standard); Collies (rough, smooth).

 

2. A dog must be entered in the name of the person who actually owned it at the time entries for a show closed.  If a registered dog has been acquired by a new owner, it must be entered In the name of its new owner in any show for which entries closed after the date of acquirement, regardless of whether the new owner has received the registration certificate indicating that the dog is recorded in his name.  State on entry form whether transfer application has been made to A.K.C. (For complete rules, refer to Chapter 14, Section 3).

 

 Junior Handlers

If this entry is for a Junior Handler, please provide the following information:

 

AKC Jr. Handler #: _________________________________________

 

Jr.’s Date of Birth: _________________________________________

 

By signing this entry form we certify that the Junior Handler does not now, and will not at any time, act as an agent/handler for pay while continuing to compete in the Junior Showmanship program.  The AKC Junior Handler number MUST be included.  Should you not have your Junior Handler number, this may be obtained from the AKC by telephoning (919) 854-0195.

 

Name of Junior Handler:______________________________________________________

 

Address: ____________________________________________________________________

 

City: ________________________________  State: _________  Zip: __________________

If Jr. Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Jr. Handler to the owner? ___________________________________