Coimadai Park NADAC Trial Entry Form - 16th & 17th January 2021

Please read the Coimadai Park NADAC trial premium document before completing your entry. The premium document can be found on the NADAC Australia website on the calendar page under the Coimadai Park trial date. The online entry form has provision for ententering up to 6 dogs on the same form. When completing your entry, please ensure all fields marked with a red asterix are completed. Trial entry fees can be made by direct bank deposit. Entry fees must be received before the entry closing date. Once you have completed your entry, please click the submit button. Your entries will be submitted electronically. Entries close by end of day Friday 8th January 2021.

First Name *

Last Name *

Owners Phone *

Email Your entry confirmation will be sent to this address *

example@example.com

Address (To ensure we have up to date details) *

Street Address

Street Address Line 2

City State

Post Code

Emergency Contact Person Name *

Emergency Contact Phone *

Please select the number of dogs being entered, as this will hide unwanted extra dog information in this entry form

How many dogs are you entering

One Two Three Four Five Six

Dog (1) Call Name *

NADAC Number-Dog 1 *

Please type in the correct format eg. 00-00000

Breed-Dog 1 *

Date of Birth-Dog 1 *

Date

Height at Shoulder in Inches-Dog (1) *

Jump Height-Dog 1 *

Prior to exemptions, divisions or categories

Breed Height Exemption-Dog 1

Yes No

What Category are You Entering-Dog 1

Proficient Skilled

Dogs Division-Dog 1

Standard Division Veteran Division

Is the Handler the same person for all dogs? When yes is selected, the handler details will be hidden for all remaining dogs to be entered

Yes No

Handlers Name *

Handler Division

Standard Handler Veteran/Disabled Handler Junior Handler

RUNS ENTERED FOR DOG (1)

ELITE

OPEN

NOVICE

INTRO

NOT ENTERED

SAT #1 Regular

SAT #2 Regular

SAT #1 Touch N Go

SAT #2 Touch N Go

SAT #1 Jumpers

SAT #2 Jumpers

SUN #1 Tunnelers

SUN #2 Tunnelers

SUN #1 Weavers

SUN#2 Weavers

SUN #1 Hoopers

SUN #2 Hoopers

Dog (2) Call Name *

NADAC Number-Dog 2 *

Please type in the correct format eg. 00-0000

Breed-Dog 2 *

Date of Birth-Dog 2 *

Date

Height at Shoulder in Inches-Dog (2) *

Jump Height-Dog 2 *

Prior to exemptions, divisions or categories

Breed Height Exemption-Dog 2

Yes No

What Category are You Entering-Dog 2

Proficient Skilled

Dogs Division-Dog 2

Standard Division Veteran Division

Handlers Name *

Handler Division

Standard Handler Veteran/Disabled Handler Junior Handler

RUNS ENTERED FOR DOG (2)

ELITE

OPEN

NOVICE

INTRO

NOT ENTERED

SAT #1 Regular

SAT #2 Regular

SAT #1 Touch N Go

SAT #2 Touch N Go

SAT #1 Jumpers

SAT #2 Jumpers

SUN #1 Tunnelers

SUN #2 Tunnelers

SUN #1 Weavers

SUN #2 Weavers

SUN #1 Hoopers

SUN #2 Hoopers

Dog (3) Call Name *

NADAC Number-Dog 3 *

Please type in the correct format eg. 00-00000

Breed-Dog 3 *

Date of Birth-Dog 3 *

Date

Height at Shoulder in Inches-Dog (3) *

Jump Height-Dog 3 *

Prior to exemptions, divisions or categories

Breed Height Exemption-Dog 3

Yes No

What Category are You Entering-Dog 3

Proficient Skilled

Dogs Division-Dog 3

Standard Division Veteran Division

Handlers Name *

Handler Division

Standard Handler Veteran/Disabled Handler Junior Handler

RUNS ENTERED FOR DOG (3)

ELITE

OPEN

NOVICE

INTRO

NOT ENTERED

SAT #1 Regular

SAT #2 Regular

SAT #1 Touch N Go

SAT #2 Touch N Go

SAT #1 Jumpers

SAT #2 Jumpers

SUN #1 Tunnelers

SUN #2 Tunnelers

SUN #1 Weavers

SUN #2 Weavers

SUN #1 Hoopers

SUN #2 Hoopers

Dog (4) Call Name *

NADAC Number-Dog 4 *

Please type in the correct format eg. 00-0000

Breed-Dog 4 *

Date of Birth-Dog 4 *

Date

Height at Shoulder in Inches-Dog (4) *

Jump Height-Dog 4 *

Prior to exemptions, divisions or categories

Breed Height Exemption-Dog 4

Yes No

What Category are You Entering-Dog 4

Proficient Skilled

Dogs Division-Dog 4

Standard Division Veteran Division

Handlers Name *

Handler Division

Standard Handler Veteran/Disabled Handler Junior Handler

RUNS ENTERED FOR DOG (4)

ELITE

OPEN

NOVICE

INTRO

NOT ENTERED

SAT #1 Regular

SAT #2 Regular

SAT #1 Touch N Go

SAT #2 Touch N Go

SAT #1 Jumpers

SAT #2 Jumpers

SUN #1 Tunnelers

SUN # 2 Tunnelers

SUN #1 Weavers

SUN #2 Weavers

SUN #1 Hoopers

SUN #2 Hoopers

Dog (5) Call Name *

NADAC Number-Dog 5 *

Please type in the correct format eg. 00-00000

Breed-Dog 5 *

Date of Birth-Dog 5 *

Date

Height at Shoulder in Inches-Dog (5) *

Jump Height-Dog 5 *

Prior to exemptions, divisions or categories

Breed Height Exemption-Dog 5

Yes No

What Category are You Entering-Dog 5

Proficient Skilled

Dogs Division-Dog 5

Standard Division Veteran Division

Handlers Name *

Handler Division

Standard Handler Veteran/Disabled Handler Junior Handler

RUNS ENTERED FOR DOG (5)

ELITE

OPEN

NOVICE

INTRO

NOT ENTERED

SUN #1 REGULAR

SUN #2 REGULAR

SUN # 1 CHANCES

SUN # 2 CHANCES

SUN #1 TUNNELERS

SUN #2 TUNNELERS

MON #1 JUMPERS

MON #2 JUMPERS

MON #1 BARRELERS

MON #2 BARRELERS

MON #1 HOOPERS

MON #2 HOOPERS

Dog (6) Call Name *

NADAC Number-Dog 6 *

Please type in the correct format eg. 00-00000

Breed-Dog 6 *

Date of Birth-Dog 6 *

Date

Height at Shoulder in Inches-Dog (6) *

Jump Height-Dog 6 *

Prior to exemptions, divisions or categories

Breed Height Exemption-Dog 6

Yes No

What Category are You Entering-Dog 6

Proficient Skilled

Dogs Division-Dog 6

Standard Division Veteran Division

Handlers Name *

Handler Division

Standard Handler Veteran/Disabled Handler Junior Handler

RUNS ENTERED FOR DOG (6)

ELITE

OPEN

NOVICE

INTRO

NOT ENTERED

SAT #1 Regular

SAT #2 Regular

SAT #1 Touch N Go

SAT # 2 Touch N Go

SAT # 1 Jumpers

SAT # 2 Touch N Go

SUN # 1 Tunnelers

SUN # 2 Tunnelers

SUN #1 Weavers

SUN #2 Weavers

SUN #1 Hoopers

SUN #2 Hoopers

Handler options for multiple dogs at Double Run format trials.

This option is only available for handlers with multiple dogs at double run format trials; where multiple dogs are entered in the same level of a course. You must decide at the time of entry, as options cannot be changed after entry submission.

Please indicate which dog you prefer to run first if you have more than one dog entered into the same level and same class

We will try to accommodate your preference, but this may not always be possible due to jump heights.

Total No of Runs Entered for this Dog 1 *

Total No of Runs Entered for this Dog 2 *

Total No of Runs Entered for this Dog 3 *

Total No of Runs Entered for this Dog 4 *

Total No of Runs Entered for this Dog 5 *

Total No of Runs Entered for this Dog 6 *

Total No of Runs Entered for all Dog *

Total Fees to be Paid for all Dogs Entered *

Account Name: Coimadai Park

BSB: 033 037

Account: 348503

Reference: Please use your given name and surname

The person who signs this agreement represents that he/she is authorized to enter into this agreement on behalf of both exhibitor and the owner of the entered dog. In consideration of the acceptance of this entry:

1.1. As used here "NADAC" means the North American Dog Agility Council, LLC. And NADAC Australia, its members, officers, directors, employees, show chairs, show committees and agents.

1.2. Exhibitor/owner agree to abide by the rules and regulations of NADAC and any other rules and regulations appearing in the premium for this event.

1.3. Exhibitor/owner certify that the entered dog is not a hazard to persons, dogs or property and that the entered dog's rabies vaccination is current in accordance with the requirement of the state in which the dog resides.

1.4. Exhibitor/owner acknowledge all hazards presented by the event and the event premises, including, but not limited to, the condition of the surface, restrooms, security measures or lack of, electrical appliances, fittings, show rings, parking areas and the presence of unfamiliar animals and people; exhibitor and owner assume the risk of any harm arising from these.

1.5. Exhibitor/owner releases NADAC (including its respective officers, directors, employees, and members),, Coimadai Park (including its officers, directors, members, and event organizing committee), Paws to Consider (including its officers, directors, members, and event organizing committee), and the Local, State and Federal Governments of Australia and will defend them and hold them harmless from all pre

Please ensure the following forms are completed:

https://www.nadacaustralia.com/covid-19-health-declaration/

https://www.nadacaustralia.com/covid-19-risk-waiver/

Owners Details

Dog/s Entered

Dog (1) Details

Handlers Details - Dog 1

Runs Entered - Dog 1

Dog (2) Details

Handlers Details - Dog (2)

Runs Entered - Dog 2

Dog (3) Details

Handlers Details - Dog (3)

Runs Entered - Dog 3

Dog (4) Details

Handlers Details - Dog (4)

Runs Entered - Dog 4

Dog (5) Details

Handlers Details - Dog (5)

Runs Entered - Dog 5

Dog (6) Details

Handlers Details - Dog (6)

Runs Entered - Dog 6

Payment

PAYMENT FOR THIS TRIAL CAN BE MADE VIA DIRECT BANK DEPOSIT

Exhibitor Agreement and Submission