2024 New England Regional Conformation Show Entry
Offering show rating, breed survey, AD, WB and dental notation.
Dog Information
Dog's Registered Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Sex
*
Male
Female
Coat Type
*
Stock coat
Long stock coat
Breed Registry (AKC, USCA, CKMU, etc)
*
Registration Number
*
Microchip/Tattoo Number
*
Please list any show rating the dog may have
Please list any working titles the dog may have
Does dog have a current breed survey?
Yes
No
If dog has a current breed survey, please select which one:
Valid 2023/2024
Lifetime
Hip Certification Rating
Please Select
SV Normal
SV Fast Normal
SV Noch zugelassen
OFA Excellent
OFA Good
OFA Fair
Other
N/A
Elbow Certification Rating
Please Select
SV Normal
SV Fast Normal
SV Noch zugelassen
OFA Normal
Other
N/A
Sire and Dam Information
Sire Registered Name
*
Sire Breed Registry (AKC, USCA, CKMU, etc)
*
Sire Registration Number
*
Sire coat type
*
Stock coat
Long stock coat
Please list any show rating or breed survey that the Sire may have
Please list any working titles that the Sire may have
Dam Registered Name
*
Dam's Breed Registry (AKC, USCA, CKMU, etc)
*
Dam's Registration Number
*
Dam coat type
*
Stock coat
Long stock coat
Please list any show rating or breed survey that the Dam may have
Please list any working titles that the Dam may have
Handler Information
Handler Name
*
First Name
Last Name
Handler will be handling dog for (select all that apply)
WB
AD
Breed survey
Show rating
BHOT/HOT
HOT
BHOT
No
If owner is handling their dog, please check this box and proceed to owner information section
Check here if information for handler is the same as owner.
USCA Membership Number
USCA Membership Expiration Date
-
Month
-
Day
Year
Date
Handler’s Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Handler’s Phone Number
Please enter a valid phone number.
Handler’s Email
example@example.com
Owner Information
Name
*
First Name
Last Name
USCA Membership Number
USCA Membership Expiration Date
-
Month
-
Day
Year
Date
Owner's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner's Phone Number
*
Please enter a valid phone number.
Owner's Email
*
example@example.com *Confirmation of your registration will be sent to this address
Co-Owner's Name (if applicable)
First Name
Last Name
Breeder Information
Breeder's Name
*
First Name
Last Name
Breeder's Address
Street Address
Street Address Line 2
City
State / Province/Country
Postal / Zip Code
Co-breeder Name (if applicable)
First Name
Last Name
Entry Information
***Please note that you will receive a separate email with payment details after your entry is received and reviewed. WB for dogs older than 13 months require special permission for entry, you will receive this form from the trial secretary to complete. Entries will not be considered complete until all required documentation and payment is received.***
Class entering
Please Select
Baby Puppy Class (4-6 months) $50 entry fee
Junior Puppy Class (6-9 months) $50 entry fee
Senior Puppy Class (9-12 months) $50 entry fee
Youth (12-18 months) $75 entry fee
Young Dog (18-24 months) $75 entry fee
Open (24+ months without a title) $75 entry fee
Working (24+ months with a title) $100 entry fee
Veteran (6+ years with title) $50 entry fee
Breed Survey
N/A
Yes, I will be entering for a breed survey ($160 entry fee)
WB Character Assessment
N/A
9-13 months ($150 entry fee)
13 months or older ($250 entry fee)
AD
N/A
Yes, I will be entering for AD ($80 entry fee)
Dental Notation
N/A
Yes, I will be entering for a dental notation ($10 fee for dental notation)
Please check here if you are declaring for 2024 Universal Sieger/Siegerin
Yes
I would like to donate toward trophy sponsorship (please enter amount)
File Upload: Pedigree (must indicate dog's tattoo/microchip number)
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File Upload: Registration
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File Upload: Rabies Certificate
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File Upload: KKL (if applicable)
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of
File Upload: Hip/Elbow Ratings (if applicable)
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File Upload: Proof of Title (if applicable, please upload image of scorebook entries)
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Liberty Working Dog Club (LWDC) and United Schutzhund Clubs of America (USCA) are not responsible for any injuries or damage suffered by persons or animals participating in this event before, during, or after the actual event. By acting as a spectator and/or participating in any capacity, I waive my right or action against LWDC/USCA and will hold LWDC/USCA harmless if any action or lack of action by my dog(s) or by me results in any action against LWDC/USCA. Dogs not entered in the show are not allowed on the show grounds.I am duly authorized agent to make this entry.
*
I have read, understand and agree to the release of Liability as noted above.
Please note for SV Breed Survey, you must have a BH, AD, and working title (IGP1, HGH, or RH2) from a WUSV recognized judge (ex SV, USCA, GSDCA, GSSCC, etc). WB is required for all dogs born on or after 07/01/2020. Additionally, orthopedic evaluations must be complete as required. Original documents will have to be sent to the USCA office for Breed Surveys, including pedigree and scorebook.
*
I am entering for a breed survey at this event and I have read, understand and agree to the above statement regarding breed survey requirements.
N/A
Submit
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