Back to the Future WDC 2021 Fall American Schutzhund Trial

Form
Back To the Future WDC 2025 Fall American Schutzhund Trial -Saturday, Nov. 22nd at Farm to Family Dog Training, 4701 Westwind Dr., Mt. Airy, MD.
Name

First NameLast Name
Email
example@example.com
Breed, Gender and age of dog
Dog's Name and Microchip number
Titles Currently Held
PSA Member Number AND expiration date
Club Affiliation
Level Competing For, see below - Owner/Handler Trained?
Level Competing For and Payment Amount: BT w/OB ($120.00) or BT environmental portion only ($75.00), BTX ($120.00), AS1, AS2, AS3 ($150.00). Alll single certifications ($80.00) PAYMENT THROUGH Venmo (user name Karen-Decker-26 last 4 digits of phone 9598) or PAYPAL user name pupsmd@aol.com. Your payment must be received for your entry to be confirmed.
By submitting this form, it is the understanding that the above handler/dog team are entering this trial AT THEIR OWN RISK. I understand that serious accidents can and do occur during dog training, competitions and other dog related events/activities. I am assuming ALL risk, liabilities and responsibilities and will hold harmless PSA K9, American Schutzhund, Back to the Future WDC, Farm to Family Dog Training, Amelia and Brian Rucker from ANY AND ALL liability arising from this dog related event and practice training while at the field. I also agree to hold harmless any of the above mentioned from any property damage , theft, death or personal injury to my dog, myself, or my guests., I agree to have complete control of myself and my dog(s) at all times. By signing this form, I acknowledge that I have read and understand the trial waiver and read and understand all PSA/AS rules that govern this trial. There will be NO REFUNDS given to any handler that has been ejected from the trial for any reason. In addition, by signing this release, I give consent to any representative of PSA/AS and Back to the Future WDC to take pictures and video of events and any activities surrounding the events. Said pictures and videos shall be the exclusive property of Back to the Future WDC for their sole and exclusive use and distribution. By signing this, I release any rights to the sale, posting or distribution of any pictures or video taken by Back to the Future WDC and waive any right to renumeration or compensation for any pictures or video taken or sold of the events in question.
Signed (print name)
Date Submitted
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

Form

Back To the Future WDC 2025 Fall American Schutzhund Trial -Saturday, Nov. 22nd at Farm to Family Dog Training, 4701 Westwind Dr., Mt. Airy, MD.