North Derbyshire Dog Agility Club
Memberships 2026/2027
Are you a new or existing member?
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New member £5 joining fee applies
Existing member
Please select a membership type?
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Adult £30
Family £40
Junior £20
Senior £20
Other
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Mobile Number
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If selecting a family membership, please state the names of all additional members below and highlight who are junior members (e.g John Smith -Junior)
Do you consent to photos and/or videos to be taken of yourselves and dogs to be used on social media and/or the North Derbyshire website?
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Yes
No
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How many dogs are you registering with North Derbyshire?
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1
2
3
4 or more
1) What is the RKC name and call name of your first dog?
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What is their DOB?
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-
Month
-
Day
Year
Date
What breed of dog are they?
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Border Collie/Working Sheepdog
Cocker Spaniel
Labrador
Papillon
Cross breed
Poodle
Miniature Australian Shepherd
Australian Kelpie
Other breed not listed here
What height do compete/train at?
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Large
Intermediate
Medium
Small
Micro
What KC grade do they compete at?
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Not applicable
Anysize
1-2
3-5
6-7
2) What is the RKC name and call name of your second dog?
What is their DOB?
-
Month
-
Day
Year
Date
What breed of dog are they?
Border Collie/Working Sheepdog
Cocker Spaniel
Labrador
Papillon
Cross breed
Poodle
Miniature Australian Shepherd
Australian Kelpie
Other breed not listed here
What height do they compete/train at?
Large
Intermediate
Medium
Small
Micro
What KC grade do they compete at?
Not applicable
Anysize
1-2
3-5
6-7
3) What is the RKC name and call name of your third dog?
What is their DOB?
-
Month
-
Day
Year
Date
What breed of dog are they?
Border Collie/Working Sheepdog
Cocker Spaniel
Labrador
Papillon
Cross breed
Poodle
Miniature Australian Shepherd
Australian Kelpie
Other breed not listed here
What height do they compete/train at?
Large
Intermediate
Medium
Small
Micro
What KC grade do they compete at?
Not applicable
Anysize
1-2
3-5
6-7
Please enter the details of any further dogs.
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1. Please tick that you understand that North Derbyshire Dog Agility Club will not be held responsible for any injuries sustained at the club to either dog and handler nor responsible for property lost or stolen?
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Yes
2. Please tick that you understand the importance of not bringing any dogs to the club when suffering from an infectious or contagious disease?
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Yes
3. Please tick to confirm your dog is of suitable temperament, physical ability and level of obedience to be able to train alongside other dogs and humans in a class environment?
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Yes
4. Do you abide by the Club Constitution, Venue Rules, Code of Conduct and Health and Safety Guidelines (available on the club website at www.nddac.org.uk)
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Yes
What is the total you are paying for your membership? £40 family, £30 adult, £20 junior/senior, £5 joining fee applies to new memberships.
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Submit
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