CDSP 11/29 NEK9A Trial Entry Form
Limit 35 dogs per trial. For more information please reference the trial premium.
Dog Information
Call Name
*
CDSP Obedience Registration Number:
*
Registered Name with CDSP Obedience:
*
Jump Height (see official jump height chart) for High Jump:
*
Jump Height (see official jump height chart) for Broad Jump:
*
JUMP HEIGHT MODIFICATION *If modification for jump height is being submitted, please select YES below and bring completed Exercise Modification Form to trials for submission to the Trial Secretary.
YES
Dog's Height:
*
Obedience Titles already earned (any venue) (rally titles are excluded):
*
Breed of Dog:
*
Dog’s Date of Birth (if known):
*
Handler Information
Owner's Name
*
First Name
Last Name
Handler's Name (if different from Owner; must be an immediate family member)
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
Entry Information
Trial #1
Class Entry
Starter Novice A
Stater Novice B
Starter Novice C
Novice A
Novice B
Novice C
Open A
Open B
Open C
Utility A
Utility B
Utility C
Entry Information
Trial #2
Class Entry
Starter Novice A
Stater Novice B
Starter Novice C
Novice A
Novice B
Novice C
Open A
Open B
Open C
Utility A
Utility B
Utility C
*Volunteers Are Needed!* Volunteers (Gate/Stewards) are needed for the trials. Lunch will be provided to all workers. If you would like to volunteer, check this box and you will be contacted if your help is needed.
I can volunteer!
Total Number of Classes Entered:
*
Total Amount Due ($30 per class):
*
I anticipate earning the following title(s):
GENERAL AGREEMENT: I (we) agree that New England K9 Athlete has the right to refuse this entry for any cause, which the organizing committee alone shall deem to be sufficient. In consideration of the acceptance of this entry, of the holding of the event, and of the opportunity to have the dog participate and/or to be judged, I (we) agree to hold the organizing committee, the hosting club(s),Companion Dog Sports Program, including their members, officers, directors,agents and employees, sponsors of the event, and owners of the premises upon which the event is held and their employees, harmless from any claim for loss or injury that may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or upon the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim. I (we) further agree to hold the aforementioned parties harmless from any claim for loss of this dog by disappearance, theft, death or otherwise, and from any claim for damage or injury to the dog, whether such loss, disappearance, appearance, theft, damage,or injury be caused or alleged to be caused by the negligence of the parties aforementioned, or by the negligence of any other person, or any other cause or causes. I (we) hereby assume the sole responsibility for and agree to indemnify and save the aforementioned parties harmless from any and all loss and expense(including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death resulting at any time there from, sustained by any person or persons,including myself (ourselves), or on account of damage to property arising out of or in consequence of my (our) participation in this event, howsoever such injuries, death, or damage to property may be caused, and whether or not the same may have been caused or may have been alleged to have been caused by negligence of the aforementioned parties or any of their employees or agents or any other persons.I (we) further acknowledge that I (we) have read,understand, and will abide by the Official Rules and Regulations of Companion Dog Sports Program and the provisions for entry as set forth in the Trial Schedule of which this entry form is a part. I (we) acknowledge and represent that the information supplied by me (us) herein is correct to the best of my(our) knowledge; if any portion of this information is found to be invalid or insufficient to establish the validity of my (our) entry, such finding shall render my (our) entry invalid in its entirety, for which there shall be no refund of fees paid. Further, I (we) represent that I am (we are) the owner(s) of the dog listed hereon, or that I (we) am (are) a family member of the dog’s owner as stated and allowed in the CDSP rules, and that I (we) shall hold the hosting club(s) and CDSP, including their officers, directors, employees and agents and their sponsors, harmless from any liability or claim made by dog’s owner.Further, I (we) hereby grant to Companion Dog Sports Program, New England K9 Athlete, their representatives, agents, and assigns,all rights and permissions to use or appropriate my and the dog’s name,biography, likeness, photograph, voice, performing persona, or other indicia or identity for broadcast, telecast, cablecast, transmission, or distribution in any format or media now known or hereafter to become known. I (we) hereby release CDSP, the hosting club(s), their representatives, agents, and assigns from any claim or cause of action for invasion of the rights of privacy, right of personality, or any similar right.
*
Date
*
-
Month
-
Day
Year
Date
I will pay by:
*
Online Below
I will mail a check
Online Payment (if not mailing a check)
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Class Entry
Please select correct quantity for number of classes entering!
$
30.00
Quantity
1
2
3
Payment Methods
Debit or Credit Card
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make your payment.
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