High Plains Entry Form

It is understood that every dog at this event will at all times be in the care and control of the dog's handler.  It is further understood that the undersigned agrees to be fully responsible of the actions of his/her dog(s) while at this event.  I agree to hold the High Plains SchH Club, Inc., as well as their members and officers and all property owners HARMLESS for loss or injury, which may have allegedly been caused directly or indirectly to any person or thing by any act of my dog(s) while on the show premises.  I hereby assume all responsibility and liability for such claims.  I further relinquish all claims and agree to hold High Plains SchH Club, Inc., their members, officers, and all property owners HARMLESS for loss and injury, which may have allegedly been caused directly or indirectly to myself or my dogs(s) during participation in this event.

Signature of Owner/Handler: ________________________________ Date:_______________

 

Please circle entry or entries:

 

SchH/IPO/VPG 1, 2, 3  $75/each               OB/TR $50

AWDF 1, 2, 3 $75         BH $50         AD $50     

Conformation Rating: $25   Breed Survey:  $110

 

Dog's Registered Name: _____________________________________________

Titles: _________________________________ Registration #: _____________

Breed: ______________________________  Birthdate: _________ M/F ___

Tattoo#: __________________ Scorebook #: ______________

Handler:_________________________________USA Member#____________

Address: __________________________________________________________

City/State/Zip: ___________________________________Phone: ____________

Owner:_________________________________USA Member#____________

Address: ________________________________________________________

City/State/Zip: ___________________________________Phone: ____________

HOT: yes   no      BHOT: yes  no  (owner/handler/trained and bred)

 

Make Checks payable to:            "High Plains Schutzhund Club"

 

(All monies to be accompanied by entry form, unless otherwise discussed)

 

Send entry to be post-marked on or before Sept. 10, 2011 to: 

Ann Marie Chaffin

34187 Cimarron Trail

Elizabeth, CO  80107

 

                                                                                    

OR copy and email to:  annmariegsd@aol.com    Phone:  303-646-4646