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official American Kennel club entry form for agility
trial Tri-state kennel club of Sanctioned “a” agility trial – ENTRIES CLOSE Entry Fee for one
dog…….$6.00 Entry Fee for same dog additional class
….$4.00 Make
Checks Payable to: Tri-State Kennel Club Mail
Entries w/fees to: Mary Patton, 775
E. Daugherty, All
classes Std. & JWW / Preferred offered at the Sanctioned Trial ENCLOSE A COPY OF THE DOG’S JUMP HEIGHT CARD.
nov a nov b open ex a ex
b nov a nov b open ex a ex b 8 12 16 20 24
preferred agility class (circle one) preferred jww (circle one) jump
height (circle one) novice open ex a ex
b novice open ex
a ex b 4 8 12 16 20
(if
offered) NOT OFFERED std jww (circle one) 14 18 26 akc registered name (Include AKC titles only) call
name of dog
ilp no. place
of birth foreign reg.
no. & country breeder sire dam actual
owners owners
address new address city,
state, zip + 4
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 event, and by any additional rules and regulations appearing in the premium list for this event, 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. I (we) agree to conduct myself (ourselves) in accordance with all such Rules and Regulations (including all provisions applying to discipline) and to abide by any decisions made in accord with them.
telephone : e-mail address:
AGREEMENT
I (we) agree that the club
holding this event has the right to refuse this entry for cause which the club
shall deem sufficient. In consideration
of the acceptance of this entry and of the holding of this event and of the
opportunity to have the dog judged and to win prizes, ribbons, or trophies, I
(we) agree to hold the AKC, the event-giving club, their members, directors,
governors, officers, agents, superintendents or event secretary and the owner
and/or lessor of the premises and any provider of services that are necessary
to hold this event and any employees or volunteers of the aforementioned
parties, and any AKC approved judge, judging at this event, 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 about the
event 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,
injury or damage to this dog. Additionally, I (we) hereby assume the sole
responsibility for and agree to indemnify, defend and save the aforementioned
parties harmless from any and all loss and expense (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 or persons, including myself (ourselves), or
on account of damage to property, arising out of or in consequence of my (our)
participation in this event, however such, injuries, death or property damage
may be caused, and whether or not the same may have been caused or may be
alleged to have been caused by the negligence of the aforementioned parties or
any of their employees, agents, or any other persons. I (we) agree that any cause of action,
controversy or claim arising out of or related to the entry, exhibition or
attendance at the event between the AKC and the event-giving club (unless
otherwise stated in its premium list) and myself (ourselves) or as to the
construction, interpretation and effect of this Agreement shall be settled by
arbitration pursuant to the applicable rules of the American Arbitration
Association. However, prior to
arbitration all applicable AKC Bylaws, rules, regulations and procedures must
first be followed as set INSTRUCTIONS(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 13 in. but not
exceeding 15 in.), Dachshunds (long-haired, smooth, wirehaired), Collies
(rough, smooth), Bull Terriers (colored, white), Manchester Terriers (standard,
toy), Chihuahuas (smooth coat, long coat), English Toy Spaniels (King Charles
and Ruby, Blenheim and Prince Charles),
Poodles (toy, miniature, standard). A dog must be entered in the name of the person who actually owned
it at the time entries for a trial 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
trial 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/her name. State on entry form whether transfer
application has been mailed to AKC. (For complete rules, refer to Chapter 11,
Section 3.) _____________________________________________________________________________________________ If this entry is for Junior Showmanship, please
give the following information: JUNIOR SHOWMANSHIP JR.’S DATE OF
BIRTH_________________________ AKC JUNIOR HANDLER
NUMBER The above number MUST be
included. Should you not have your Junior Handler number, this may be obtained
from the American Kennel Club. Phone: (919) 816-3776. ADDRESS_____________________________________________________________________________________
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