Ckc Approved Retriever Trial Official Premium List For A Trial To Be Held At Swallowfield Farm, Crofton B.c. (Page 4 of 4) in pdf

OFFICIAL ENTRY FORM

(Retriever Field Trial)

OFFICIAL ENTRY FORM

(Retriever Field Trial)

Name of Club:

Date Of Event:

EVENT INFORMATION

FEES:

Entry Fee

Listing Fee

Total Enclosed

FEES:

Entry Fee

Listing Fee

Total Enclosed

STAKES ENTERED (Separate Entry Form must be provided for each stake):

Junior

Open

Special

O/H Amateur All-Age

Junior

Open

Special

O/H Amateur All-Age

Qualifying

Limited

Amateur All-Age

Unofficial

Qualifying

Limited

Amateur All-Age

Unofficial

Limited All Age Stake

Qualified

Not Qualified

Limited All Age Stake

Qualified

Not Qualified

DOG INFORMATION

Registered Name of Dog:

Breed:

Call Name:

Male

Female

Breed:

Call Name:

Male

Female

CKC Registration #

CKC Miscellaneous #

CKC Registration #

CKC Miscellaneous #

Insert Number Here:

___________________________________

Insert Number Here:

___________________________________

CKC ERN #

Listed

CKC ERN #

Listed

Date of Birth:

Place of Birth:

Canada

Elsewhere

Date of Birth:

Place of Birth:

Canada

Elsewhere

Breeder:

Sire:

Dam:

OWNER(S) & AGENT INFORMATION

Registered Owner(s):

Membership No.

Registered Owner(s):

Membership No.

Handler:

Amateur

Professional

Handler:

Amateur

Professional

Owner’s Address:

Name of Agent (if any) :

Agent’s Address:

Street Address

City

Prov.

Postal Code

Street Address

City

Prov.

Postal Code

I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the actual owner(s) whose name(s) I have entered above and accept full responsibility for all

statements made in this entry. In consideration of the acceptance of this entry, I (we) agree to be bound by the rules and regulations of The Canadian Kennel Club and by any additional

rules and regulations appearing in the premium list.

I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the actual owner(s) whose

(

)

I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the actual owner(s) whose

(

)

Signature of Owner or Agent

Telephone Number

Signature of Owner or Agent

Telephone Number

name(s) I have entered above and accept full responsibility for all statements made in this entry. In consideration of