OG Patriot Club Trial &AD Registration

NOTE: THIS IS A REGISTRATION FORM FOR THE 6 - 7 DECEMBER 2025 CLUB TRIAL & AD. PLEASE FILL OUT THE APPROPRIATE PORTIONS, UPLOAD REQUIRED DOCUMENTS, SUBMIT THE FORM AND MAKE PAYMENT.

THIS FORM IS DESIGNED TO COVER SEVERAL DIFFERENT TYPES OF REGISTRATION AND NOT ALL BLOCKS NEED TO BE FILLED OUT OR CHECKED.

PLEASE READ THROUGH THE FORM CAREFULLY TO ENSURE YOU FILL OUT THE APPROPRIATE INFORMATION.

TENTATIVE SCHEDULE

6 DECEMBER 2025: IGP PHASES

7 DECEMBER 2025: AD (ENDURANCE TEST)

WE LOOK FORWARD TO SEEING YOU ALL THERE!

- ENTRY DEADLINE IS 30 NOVEMBER 2025
EVENT ADDRESS:

4262 Turnersville Rd, Cedar Hill, TN 37032

Point of Contact: Christopher Lee

Phone: 334-379-9317

Email: clee3838@yahoo.com
DOG INFORMATION
Registered Dog Name
Dog "Call" Name
Breed of Dog
Titles
Date of Birth

MonthDayYear
Date
Microchip/Tattoo #
Registration #(s)
Scorebook #
Sex

MaleFemale
Handler
Name
Address

Address

Street Address Line 2

CityState

ZipCountry
Phone
E Mail
example@example.com
Organization you are a member of (e.g. USCA, AWDF)
Membership #
Name of the Club where the Handler conducted a previous BH
Date when the Handler conducted a previous BH

MonthDayYear
HOT (Handler Owner Trainer) NOTE: To qualify as Handler Owner Trained (H.O.T.), the following criteria must be met: 1. The dog must be owned and registered in the name of the handler. 2. A significant amount of the training of the dog may not have been done by someone other than the owner without the owner being involved in the training; (e.g., the dog may not have been sent to a trainer for the retrieve, heeling, protection, or tracking) 3. The dog may not have been trained to the level of being ready to pass a BH before purchase.

YesNo
Dog Owner (If different from Handler)
Name
Address

Address

Street Address Line 2

CityState

ZipCountry
Phone
E Mail
example@example.com
Organization you are a member of (e.g. USCA, AWDF)
Membership # (USCA# if registering for Breed Survey)
Helper (For Seminar / Classification Only)
Name
Address

Address

Street Address Line 2

CityState

ZipCountry
Phone
E Mail
example@example.com
Membership # (USCA#)
Membership expiration date
Helper Book #
Current Classification (If applicable) (e.g. Basic, Club, etc.)
Classification being sought
Number of dogs worked from Helper Book (if applicable)
REQUIRED PAPERWORK - Please not that if you are entering for a BH, IGP Title or the AD, you are only required to upload the following: - Current Membership card - Dog Registration Form - Proof of Rabies Vac

One Scorebook per Dog entered (Upload Copy showing Title if entering for Working Class Show or Breed Survey)Current Membership CardDog Registration FormProof of Rabies Vaccination
REQUIRED EQUIPMENT FOR HELPER SEMINAR / CLASSIFICATION - Please note that it is recommended that you bring a dog capable of performing an IGP 3. However, a dog capable of performing an IPG 1 is acceptable and appreciated. If you are unable to bring a dog, please inform the event POC so arrangements can be made.

Helper ScorebookCurrent Membership CardPadded StickScratch Pants & JacketAppropriated Footware (Cleats recommended)
BH-VT, IGP Titles, AD, Helper Seminar / Classification - Choose Appropriate Box you are entering for with associated USCA member fee. - NOTE: All NON-USCA members are required to pay an additional $30 processing fee (For example, a BH-VT entry fee will be $105, an IGP 1 entry fee will be $130.)

BH-VT $75GPr 2 $100FPr 1 (Tracking Only) $85GPr 3 $100FPr 2 $85IGP 1 $100FPr 3 $85IGP 2 $100UPr 1 (Obedience Only) $85IGP 3 $100UPr 2 $85AD $100UPr 3 $85Helper Seminar / Classification $100GPr 1 (Obedience & Protection) $100
Submit entry form when complete. If you experience issues with the registration form please contact Christopher Lee via email (clee3838@yahoo.com) or by phone 334-379-9317 and we will work through the process.

Required documents must be uploaded.

Note:

- If documents are missing or incorrect, you will be contacted via email in order to correct the issues.

- It is recommended to bring your original documents in the event of discrepencies.

Payment methods:

1. Mail a check to: Christopher Lee, 4262 Turnersville Rd, Cedar Hill, TN 37032

or

2. Pay online through Venmo: @Christopher-Lee-481

or

3. Pay online through CashApp: $LeeChr

Please note in an email which payment method you have submitted.
Signature

Clear
I am the

owner orduly authorized agent of this entry and all of this information is correct.
Printed Name
Date

MonthDayYear
Date
Incomplete entries, entries that are not signed, and entries without proper documents provided at the event will not be accepted. Entries that are not received on or before the event deadline date will only be accepted on a case-by-case basis and there will be a $25 late fee, if space is still available.

Release, Waiver of Liability, and Indemnity Agreement

I hereby acknowledge that I have voluntarily applied to participate in activities sponsored by the O.G. Patriot Schutzhund Club (hereby referred to as "CLUB"), being held on the property of 4262 Turnersville Rd., Cedar Hill, TN 37032 (hereinafter referred to as "Field").

I am aware that these activities may involve risk of bodily injury, death, or property damage, and I am voluntarily participating with knowledge of the risks. I expressly assume the risk of these dangers, including, but not limited to, slips, falls, and/or injury from equipment. As lawful consideration for being permitted by CLUB to engage in these activities on the property of Field, I hereby release, waive, discharge, and relinquish any action or causes of action for personal injury, property damage, or wrongful death, against CLUB, her/his heirs, executors, administrators, and assigns, which may hereafter arise from the activities or any pursuit incidental thereto.

I hereby agree that under no circumstances shall I prosecute or present any claim against Field for any causes of action, for personal injury, property damage, or wrongful death, whether the same shall arise by negligence or non-intentional conduct of anyone from the activities or any pursuit incidental thereto. This Agreement shall bind the members of my family and my spouse, my heirs, assigns, and personal representatives, and shall be deemed as a RELEASE, WAIVER, AND DISCHARGE OF LIABILITY, AND COVENANT NOT TO SUE the above-named CLUB. This agreement does not restrict my rights in regard to actions against the CLUB.

I understand and agree that I shall be personally responsible for my own safety during these activities and assume all risks and accept full and complete responsibility for any and all damages and personal injury of any kind, including death. Only those dogs entered in the event will be allowed on the event grounds.

I HEREBY AGREE TO INDEMNIFY, SAVE, AND HOLD HARMLESS THE CLUB, HER/HIS HEIRS, EXECUTORS, ADMINISTRATORS, AND ASSIGNS FROM ANY LOSS, LIABILITY, DAMAGE, OR COST, INCLUDING ATTORNEYS' FEES, WHICH I MAY INCUR AS A RESULT OF INJURY, DEATH, OR PROPERTY DAMAGE, OR FROM ANY SUIT FROM SUCH PERSONAL INJURY, DEATH, AND/OR PROPERTY DAMAGE.

If any part of this agreement is determined to be invalid by a Court of law, it is agreed that the balance of the Agreement shall continue in full force and effect.

I HAVE READ AND VOLUNTARILY SIGNED THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT AND FURTHER AFFIRM THAT NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.

I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT.
Signature

Clear
Printed Name
Upload Required Documents Here.

Cancelof
NO REFUNDS UNLESS EVENT CANCELLED!

Reference is hereby made to the Release, Waiver of Liability and Indemnity Agreement. By this reference, the Release is incorporated herein as though set forth in full.

This "Release" is located at the end of this document and must be read before signing the entry form.
Should be Empty:

DOG INFORMATION

Handler

Dog Owner (If different from Handler)

Helper (For Seminar / Classification Only)