PSA Trials - August 2024

Name*

First NameLast Name

ID Number*

Owner’s name (If different from the handler) – remember that the owner must be a member of PSA and must be the one to purchase the scorebook.

First NameLast Name

Member Number (you can check your membership number and member status by visiting https://psak9-as.org/membership-list/. If you are not a member, or need to renew, you must do so as soon as possible before the trial date.

If you have not yet received just note - Awaiting number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Emergency Contact *

First NameLast Name

Emergency Contact Number*

Please enter a valid phone number.

Email*

example@example.com

Dogs Name (Registered Name)*

Dog also known as:*

Breed*

Age of Dog*

Song Title & Artist to play on entry *

Please make sure this is given to our show secretary on the Friday before the trials start!A MP3 Stick is preferred.

Interesting /Fun Facts about your dog *

Is the dog owner trained?*

YesNo

Which club are you affiliated with? (If none, please state none)

Which level do you want to participate in, on day 1?*

Which level do you want to participate in, on day 2?

ENTRY FEE DETAILS
TRIAL FEE AMOUNT: R500.00 (Non-Refundable)

NEXT LEVEL (DAY 2): R500.00 (subject to changes)

BANKING DETAILS:
Account Name: Get A Grip Club
FNB, Acc no: 62807038460
Hartebeespoort
Ref: Name & Surname
Email POP to Jenny@psaafrica.com Ref: Member Number & Dog name

By you 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 USA, PSA Africa, Get a Grip, Legacy K9 & Prey Monsters PSA Club, hosting venue, their agents, partners, members, employees, sponsors from ANY AND ALL liability arising from this dog- related event and practice training while at the trial eld. 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 always have COMPLETE control over myself and my dog(s). All dogs are to be crated while not competing. If your dog must go potty, then they must be always on a lead and under COMPLETE control. All dogs are to always have adequate fresh water in their crates. By signing this registration form, I acknowledge that I have read and understood the trial wavier and read and understood all PSA rules that govern this trial. There will be NO REFUND given to any handler that has been ejected from this trial for any reason. In addition, by signing this release, I consent to any representative of PSA and Get a Grip, Legacy K9 & Prey Monsters PSA Club to take pictures and video of events and any activities surrounding the events. Said pictures and video shall be the exclusive property of Get a Grip, Legacy K9 & Prey Monsters PSA Club their sole and exclusive use and distribution.

Date*

Signed at*

Signature*