2026 American Schutzhund Roundup Registration
Participant Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Zip Code
Contact Number
Format: (000) 000-0000.
Email
example@example.com
Trial Information (BT/BTX/ Independent Independent Environment Evaluation Only)
Owner's Name
Handler's Name
Dog's Registered Name
Dog's Breed
Dog's Sex
Dog's Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Microchip/Tattoo Number
PSA Membership Number / Expected Date
Scorebook (Yes/No)
Back
Next
Event Selection
Training Saturday & Sunday
Training Saturday Only
Training Sunday Only
BT Sunday ($25)
BTX Sunday ($25)
Independent Environment Evaluation Sunday ($25)
Dinner Saturday (Participant)
Dinner Saturday (Spectator with AS Membership)
Dinner Saturday (Spectator $25)
Payment Info
Venmo: Karen-Decker-26 (Last 4: 9598)
PayPal: pupsmd@aol.com
Waiver & Liability Agreement
By submitting this form, it is the understanding that the above handler/dog team are entering this trial AT THEIR OWN RISK I understand that serious accidents can and do occur during dog training, competitions and other dog related events/activities I am assuming ALL risk, liabilities and responsibilities and will hold harmless PSA K9, American Schutzhund, Back to the Future WDC, Farm to Family Dog Tra I also agree to hold harmless any of the above mentioned from any property damage, theft death or personal injury to my dog, myself, or my guests I agree to have complete control of myself and my dog(s) at all times By signing this form, I acknowledge that I have read and understand the trial waiver and understand all PSA/AS rules that govern this trial There will be NO REFUNDS given to any handler that has been ejected from the trial for any reason In addition, by signing this release, I give consent to any representative of PSA/AS and Back to the Future WDC to take pictures and video of events and any a Said pictures and videos shall be the exclusive property of Back to the Future WDC for their sole and exclusive use and distribution By signing this, I release any rights to the sale, posting or distribution of any pictures or video taken and waive any right to compensation.
Signature
Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: