Dog Information
Registered Name
*
Registration Organization
*
AKC
USCA
Other
Registration Number
*
Microchip or Tattoo #
*
Breed
*
Sex
*
Female
Male
Birth Date
*
-
Month
-
Day
Year
Date
Working Titles (or N/A)
*
Scorebook Organization
*
USCA
GSDCA
AWDF
DVG
Other
Scorebook #
*
HOT
*
Yes
No
Handler Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Membership Organization
*
USCA
GSDCA
AWDF
DVG
Other
Membership #
*
Expiration Date
*
Club and Date Where Handler Acquired BH (or N/A)
*
Owner Information
If different from Handler
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Entry Information
Entry Title and Fee
*
BH-VT $70
IGP 1 $80
IGP 2 $80
IGP 3 $80
GPr 1 $70
GPr 2 $70
GPr 3 $70
FPr 1 $65
FPr 2 $65
FPr 3 $65
UPr 1 $65
UPr 2 $65
UPr 3 $65
USCA Member?
*
Yes
No, Add $50 fee
Total Entry Fee Amount (must send via PayPal to "Raleigh Schutzhund Association" to complete entry)
*
Release
(1) I will be fully and solely responsible for the actions of myself, my family and my dog(s) while engaged in any club activities, whether on club property, tracking fields, training grounds, competitions, shows or any other location; (2) I will maintain control of and be responsible for the welfare of my dog(s)during all club-related activities; (3) I hereby waive, release, hold harmless and defend this club, its officers, directors, members, guests, club and third-party trainers/educators, judges, agents, property owners and their successors from any and all claims of loss, injury or disease to myself, my family members, my property or my dog(s) a rising directly or indirectly from, or in any way related to, participation in or attendance at any activities of this club whether on or off club property; (4) To the fullest extent permitted by law, I shall indemnify, hold harmless and defend this club, its officers, directors, members, guests, spectators, club and third-party trainers/educators, judges, agents, property owners and their successors and assigns from any and all claims of loss, injury or disease to any other persons, dogs or property arising directly or indirectly from, or in any way related to, the participation of myself, my family or my dog(s) in, or attendance at, any activities of this club whether on or off club property; (5) In case of emergency, the club may in its sole discretion authorize medical treatment for my family, my dog(s), or myself; (6) The club has my permission to take and use photographs, videotapes and other recordings of club activities involving myself, my family or my dog(s) for any lawful purpose without compensation; and (7) I will abide by club and event rules. The club hereby disclaims any undertaking to protect personal property, including vehicles and contents, equipment, cameras and valuables, from loss, theft, damage or vandalism and disavows any responsibility for any and all such losses that may occur at any club activity. By submitting this form, I certify that my dog(s) are physically and mentally fit for training, competition, and contact with the public, dogs and other participants, have current rabies and other vaccinations and are free from all communicable diseases.
*
By checking this box, I agree to the above.
Submit
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