Trial Entry Form
November 21st, 2026
2827 NY-52, Pine Bush, NY 12566
Judge: Erin O'Shea
Helpers:
Registered Name of Dog
*
Call Name
*
Breed
*
Date of Birth
*
Sex
*
Please Select
Male
Female
Neutered Male
Spayed Female
Registration Organization's and #'s (USCA/ AKC/ Other)
*
Scorebook Organization and #
*
Microchip #
*
Present Titles
Rabies Certificate
*
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Handler 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.
Format: (000) 000-0000.
Email
*
example@example.com
USCA Member #
Club Affiliation
Owner name if different from Handler
Handler- Owner- Trained
Please Select
Yes
No
Title Entering (for any Non USCA members an additional $40 will be added to the below fees)
*
Please Select
BH $75
IGP 1 $125
IGP 2 $125
IGP 3 $125
Other
If Title not in drop box above type in box below (GPr1-3 (Obedience and Protection),FPr1-3 (Tracking Only),UPr1-3 (Obedience Only))
Venmo Please note HVWDK Trial and what title your entering.
I, the undersigned, understand participation at this trial is at my own risk. I will not hold Hudson Valley Working Dog Klub, any of it's members, member dogs, or Ruff Haus Kennels responsible for damages that may occur to my person, property, or dog(s) as a result of this trial or trial prep training. I herby release the above mentioned parties from any and all liability, claims, demands, actions, medical bills, and causes of action whatsoever arising out of or relating to any negligent or other act of ommission or happenstance, and/or any loss, damage, or injury, including death, that may be sustained by the undersigned, or by any property or dogs of the undersigned, from participating in this event and its training. I understand that I am fully responsible for the actions of my dog(s) as well as any damage or injury that may occur due to their actions.
Signature
*
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