2027 SOUTHEAST REGIONAL CHAMPIONSHIP

2027 SOUTHEAST REGIONAL CHAMPIONSHIP

MARCH 11-14, 2027
HANDLER INFORMATION
Handler Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Member Organization
Membership Number/Expiration Date
Regional Affiliation
Club Affiliation
1st Time Regional Competitor?
Youth Handler?
OWNER INFORMATION

Leave Blank if Same as Handler
Owner's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
DOG'S INFORMATION
Name
AS WRITTEN IN SCOREBOOK
Birth Date

MonthDayYear
Date
Gender
Registration Number
Microchip/Tattoo Number
Breed
Scorebook Number
BHOT
HOT
Current Titles:
Breed Survey (GSD only)
Title Entering For:
Proof of Rabies Vaccine

Cancelof
Handler/Dog Picture

Cancelof
PAYMENTS
CHECKS:

Payable to: Charleston Working Dog Club

Mail to: Stacey Neal

167 Cascade Dr, Bowman SC 29018

VENMO:

@charlestonworkingdogclub

Will show as M TAYLOR

Last 4 of phone # 9608

PAYPAL:

CascadeMalinois@gmail.com

Will show as Stacey Neal

If you use PayPal or Venmo please give your name and your dogs name.
Please read the statement below and sign:

It is hereby understood that every dog at this event will be under the direct care and control of its handler. The undersigned agrees to be fully responsible for any and all actions of their dog including dogs owned by another but in the undersigned’s care. The undersigned agrees to hold harmless all members, officers and directors of Charleston Working Dog Club, the United Schutzhund Clubs of America and any property owners associated with this event in case of an accident, injury or loss that may occur on or near the trial grounds, before, during or after the event. Handlers and owners agree to abide by all the rules of United Schutzhund Clubs of America. I hereby assume all responsibilities and liabilities for my dogs and myself and agree to abide by all USCA guidelines and the rules set forth for this trial by Charleston Working Dog Club and/or trial judge.
Signature
Should be Empty:

2027 SOUTHEAST REGIONAL CHAMPIONSHIP

HANDLER INFORMATION

OWNER INFORMATION

DOG'S INFORMATION

PAYMENTS

Please read the statement below and sign: