Cca Official Entry Form - Glassfibre Reinforced Concrete Association

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CCA OFFICIAL ENTRY FORM
Club Name
Date
A:___________________ B:____________________C:___________________
Q NQ DQ
Q NQ DQ
Q NQ DQ
DOG’S REGISTERED NAME (copy of AKC registration must be attached)
ENTRY FEE
SEX
MALE
FEMALE
ENCLOSED $
ALTERED
ENTER NUMBERS HERE FOR
DATE OF BIRTH
AKC REG
PLACE OF BIRTH
CKC REG
USA
CAN
OTHER
ILP NO.
PERMANENT ID NUMBER ENTER HERE
□ MICROCHIP □ TATTOO □ DNA REG.
BREEDER
SIRE
DAM
OWNER
OWNER’S ADDRESS
CITY, STATE (PROV), ZIP OR POSTAL CODE
□ I have enclosed a photocopy of the dog’s AKC or CKC registration
certificate. (Required per GRCA Res MY 16-18)
I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual
owner whose name I have entered above. In consideration of acceptance of this entry, I (we)
agree to abide by the regulations of the GRCA governing this event, and by any additional rules
and regulations appearing in the premium list for this event, and further agree to be bound by the
Agreement printed on the reverse side of this entry form. I (we) certify and represent that the dog
entered is not a hazard to persons or to other dogs. This entry is submitted for acceptance on the
foregoing representation and agreement.
_____________________________________ ______________________________
Signature of authorized Owner or Agent
Phone Number
Email Address:

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