ULTIMUTT Barn Hunt Registration

Ultimutt Barn Hunt Registration
Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Dog's Name*
Dog's Date of Birth*

MonthDayYear
Date. If unsure, please guess approximate Date.
Breed and Color
VACCINATIONS

We require proof of the following:

• *Bordetella (the intranasal 6 month that includes Adenovirus, Parainfluenza, and Bordetella is highly recommended)

• DHLPP annual or equivalent (or puppy series)

• Rabies 1 year or 3 year (once old enough for puppies)

• *Highly Recommended:

Canine Influenza (H3N2 or H3N2/H3N8.

*These are not part of the regular vaccines routinely given and have to be

.
My dog is current with the following vaccinations:*

RabiesBordetellaCanine InfluenzaDHLPP annual or equivalent (or puppy series)My dog is Titered for some of the above shots
Vaccination explanation - if your dog doesn't have all the required vaccinations
Which best describes your dogs energy level?*

LowMediumHIgh
Are there any types of PEOPLE that your dog dislikes? Please explain.*
If Not, type None
Are there any types of ANIMALS that your dog dislikes? Please explain.*
If Not, type None
Has your dog ever bitten anyone?*

NoYesIf yes, please explain
Does your dog had any Barn Hunt experience?*

NoYesif yes, how much?
Has your dog been in any Barn Hunt trials?*

NoYes
If Yes is marked above what is highest level? How many rats does your dog typically search for at a time?
Please provide other comments or information about your dog that you feel might be helpful:
How did you hear about us?*

Internet SearchFacebookInstagramFrom my VetWord of Mouth/From a FriendOther
Image Release*

I grant permission to post pictures of my dog(s) with their name on Ultimutt Knoxville website, on social media (Facebook, Instagram, etc.) and/or in other print and video/TV media related to Ultimutt Knoxville.I grant permission to post pictures of my dog(s) without their name on Ultimutt Knoxville website, on social media (Facebook, Instagram, etc.) and/or in other print and video/TV media related to Ultimutt Knoxville.Do not use my images at all
By e-signing this form, I accept the risks in the statements in the waiver above and I certify that the information provided in this form is accurate and true to the best of my knowledge. *

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Ultimutt Barn Hunt Registration