Official Obedience Entry Form - American Kennel Club

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OFFICIAL OBEDIENCE ENTRY FORM
AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club website,
AGREEMENT
I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient.
In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to have the
Brernese Mountain Dog Club of Northern California
June 6, 2014
dog judged and to win prizes, ribbons, or trophies, I (we) agree to hold the AKC, the event-giving club, their members,
Solano County Fairgrounds: 900 Fairgrounds Dr., Vallejo, CA 94589
directors, governors, officers, agents, superintendents or event secretary and the owner and/or lessor of the premises
and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned
Obedience #2014615701 Entry Fee: $25/$15
Rally #2014615703Entry Fee: $25/$15
parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may
Mail to Lorie Abbott, 2144 Broadmoor St., Livermore, CA 94551
be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the
Must be sent no signature required
Entries Close: May 21, 2014
event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for
any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss, injury or
I ENCLOSE $ ________for entry fees
damage to this dog.
Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned
IMPORTANT-Read Carefully Instructions on Reverse Side Before Filling Out. Numbers in the boxes indicate sections of the
parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon
instructions relevant to the information needed in that box (PLEASE PRINT)
any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom,
sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or
BREED
4
VARIETY
1
SEX
BMD
in consequence of my (our) participation in this event, however such, injuries, death or property damage may be caused,
and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the
aforementioned parties or any of their employees, agents, or any other persons. I (WE) AGREE THAT ANY CAUSE OF
2,3
2,3
OBEDIENCE CLASS
JUMP HEIGHT
ADDITIONAL OBEDIENCE CLASS
ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTEN-
DANCE AT THE EVENT BETWEEN THE AKC AND THE EVENT-GIVING CLUB (UNLESS OTHERWISE STATED
IN ITS PREMIUM LIST) AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTERPRETATION AND
2,3
2,3
ADDITIONAL OBEDIENCE CLASS
ADDITIONAL OBEDIENCE CLASS
EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE
RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICA-
BLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH
JR. HANDLER
NAME OF (See Back)
IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES.
NUMBER
JUNIOR HANDLER (If any)
INSTRUCTIONS
FULL
1. (Variety) if you are entering a dog of breed in which there are varieties for show purposes, please designate the particular
NAME
variety you are entering, i.e., Cocker Spaniel (solid color black, ASCOB, parti-color), Beagles (not exceeding 13
OF DOG
in., over 13 in. but not exceeding 15 in.), Dachshunds (longhaired, smooth, wirehaired), Collies (rough, smooth), Bull
Enter number here
DATE OF
Terriers (colored, white), Manchester Terriers (standard, toy), Chihuahuas (smooth coat, long coat), English Toy Spaniels
BIRTH
AKC
®
NO.
(King Charles and Ruby, Blenheim and Prince Charles), Poodles (toy, miniature, standard).
PAL/ILP NO.
PLACE OF
FOREIGN REG NO.
2. (Event Class) Consult the classification in this premium list. If the event class in which you are entering your dog is
BIRTH (list country)
Do not print the above in catalog.
divided, then, in addition to designating the class, specify the particular division of the class in which you are entering
BREEDER
your dog, i.e, A or B division.
SIRE
3. A dog must be entered in the name of the person who actually owned it at the time entries for an event closed. If a
registered dog has been acquired by a new owner it must be entered in the name of its new owner in any event for which
DAM
entries closed after the date of acquirement, regardless of whether the new owner has received the registration certificate
indicating that the dog is recorded in his/her name. State on entry form whether transfer application has been mailed to
3
the AKC. (For complete rules, refer to Chapter 11, Section 3. of the Rules Applying to Dog Shows.)
ACTUAL OWNER(S)___________________________________________________________________________________
(Please Print)
4. Dogs listed in the AKC Canine Partners
Program may be eligible to enter all-breed AKC Obedience trials
SM
OWNER’S ADDRESS___________________________________________________________________________________
at the club’s option. These dogs should be listed as All American Dog and must include their AKC Number on the
CITY__________________________________________________STATE_____________________ ZIP________________
entry form and check the AKC No. box. Sire and Dam information shall remain blank for mixed breed entrants.
HANDLER: ______________________________________________________________________________________________
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
If this entry is for a Junior Handler, please give the following information:
above. In consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of the American Kennel
JR.’S DATE OF BIRTH
Club in effect at the time of 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
AKC JUNIOR HANDLER NUMBER
entered is not a hazard to persons or other dogs. This entry is submitted for acceptance on the foregoing representation and
Agreement. I (we) agree to conduct myself (ourselves) in accordance with all such Rules and Regulations (including all provisions
The above number MUST be included. Should you not have your Junior Handler number, this may be obtained from the
applying to discipline) and to abide by any decisions made in accord with them.
American Kennel Club. Phone: (919) 233-9767.
SIGNATURE of owner or his/her agent
By signing the entry form I (we) certify that the Junior Showman does not now, and will not at any time, act as an
duly authorized to make this entry ________________________________________________________________________________
agent/handler for pay while continuing to compete.
TELEPHONE #_______________________________________________________________________________________________
ADDRESS___________________________________________________________________________________________________
Are you a new exhibitor?
Yes
No
CITY_______________________________________________________ STATE____________________ ZIP__________________
Email Address (An acknowledgement or receipt of entry may be sent to this e-mail address):
If Junior Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Junior Handler to the Owner?
____________________________________________________________________________________________________________
AO9999 (05/12) v1.5P Edit

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