AKC All-Breed Agility Trials (Licensed by the American Kennel Club)

Transcription

1 Premium List Event #: Friday (# ) Saturday (# ) Sunday (# ) Friday, November 24, 2017 Saturday, November 25 and Sunday, November 26, 2017 AKC All-Breed Agility Trials (Licensed by the American Kennel Club) Open to Dogs Listed with the AKC Canine Partners Program. Classes Offered: Friday-- Standard & Jumpers with Weaves: Mas/Exc only, T2B Saturday--All Levels: Standard, Jumpers with Weaves, T2B Sunday--All Levels: Standard, Jumpers with Weaves Method of Entry--First Received Entries Limited to 330 Runs Each Day Camp Bandy Pet Resort, 9376 Lake Emily Road Amherst Junction, WI Entries open Monday, October 13, 2017 at 8:00am. Any entries received before this date will be returned. All express mail must be left with no acceptance signature required. No hand delivered entries accepted until 24 hrs after opening. Any envelope, mailed or hand delivered, containing more than the ten dog maximum constitutes an invalid entry and will be returned. Entries close Friday, November 10, 2017 at 5:00pm at the Trial Secretary s address, after which time entries cannot be accepted, canceled, altered, or substituted except as provided for in Chapter 11, Section 6 of the Dog Show Rules. Show hours: Friday 12:00pm-6:00pm, Saturday and Sunday 7:00am-6:00pm AMERICAN KENNEL CLUB CERTIFICATION Permission has been granted by the American Kennel Club for the holding of this event under American Kennel Club Rules & Regulations. James Crowley, Secretary.

2 Mail all entries with fees (check or money order) payable to CAMP BANDY to: Lorah Marquardt, TROCCW/WRKC Bluestem Agility Trial Services, LLC 1124 W River Drive, Stevens Point WI Questions? Call: Or (preferred): bluestemk9@att.net Entry fee of $18.00 per class (includes $3.50 AKC recording fee for the first entry of each dog per day and 3.00 AKC recording fee for each additional entry of the same dog/same day) WAIT LIST FOR WITHDRAWN ENTRIES: A Wait List of a maximum of 25 entries will be maintained to fill openings created by entries withdrawn after the closing date. All entries, including wait listed entries, must be received prior to the closing date. Written notice to withdraw an entry must be received by the Trial Secretary no later than 6pm on Monday, November 20, If a withdrawn entry is replaced by a wait listed entry, a full refund will be issued for the withdrawn entry. Any wait listed entry that does not move off the wait list into the trial, will receive a full refund. TROCCW OFFICERS President: Linda Redfield Vice President: Laurie Bandy Treasurer: Ann Hanson Secretary: Jocelyn Reid 1805 Bobby Ln Stevens Point WI Board: Brenda Blume, Mary Ann Ralston, Jared Redfield, Kathy Schuh WISCONSIN RAPIDS KENNEL CLUB OFFICERS President: Shirley LaBarge Vice President: Ilene Havitz Treasurer: Roger LaBarge Secretary: Lori Whitney rd St S Wisconsin Rapids, WI Board: Deb DeByl, Mary Kay Helbach, Sherry Rady, Vic Saeger, Kathy Schuh EVENT COMMITTEE Event Chair: Laurie Bandy, 9376 Lake Emily Rd, Amherst Jct WI , laurie@campbandy.com Members: Laurie Bandy, Steve Bandy, Mary Ann Ralston, Kathy Schuh, Joan Simon Volunteer Coordinator: Jane Zank, mission@tds.net TRIAL JUDGE Ronda Bermke, 3007 Ridge Ct, Greenleaf, WI VOLUNTEER WORKER SIGN-UP TROCCW/WRKC November 24, 25 & 26, ONLINE WORKER SIGN UP AN WILL BE SENT TO ALL ENTRANTS WHEN SIGN UP BECOMES ACTIVE. If you do not have an address or access to the internet, fill in the sign up form and mail it in with your entry. Please do this only if you can't access the internet. Name: Address: (if no ) Phone: Check classes you would be willing to work in (not those you are entering): Fri Sat Sun Mas/ Exc Std Mas/ Exc JWW 16-4 Premier Std XX XX XX Premier JWW XX XX XX Open Std XX Open JWW XX Nov Std XX Nov JWW XX Time 2 Beat XX Check jobs you would be willing to work: Job: Fri Sat Sun Course Builder Timer Scribe Gate Steward Ring Crew Scribe Sheet / Leash Runner Thanks for volunteering Your help is greatly appreciated! Contact volunteer coordinator Jane Zank, mission@tds.net with any questions.

3 AKC AGILITY MOVE-UP FORM MOVE-UP REGULATIONS: If a dog earns an AKC agility title before this event, it can be advanced to the next level of competition. However, written notice must be given to the Trial Secretary no later than 6pm on Monday, Nov 20, Day to day move-ups will be accepted if received before the close of the trial Friday, Nov 24 or Saturday Nov 25, Trial close will be considered to be the awarding of ribbons for the last class on that day. Every effort will be made to accommodate handlers running multiple dogs in the same class. Move-up form must be submitted Verbal requests will not be accepted. Fill out each change and send to the Trial Secretary s home address. ed requests accepted as long as all information is included AKC Registered Name: AKC Registration #: Breed: Call name: Owner(s): Days Move-up requested for: Height Division: STD Move to: Open Exc Mas STD Pref Move to: Open P Exc P Mas P JWW Move to: Open Exc Mas JWW Pref Move to: Open P Exc P Mas P FAST Move to: Open Exc Mas FAST Pref Move to: Open P Exc P Mas P RUNNING ORDER: Friday Saturday Sunday 11:45 AM Briefing and Walk-throughs 12:00 PM Judging begins TIME 2 BEAT MAS/EXC STD MAS/EXC JWW Big to Little Building opens at 11:00am on Friday and 6:30am on Saturday and Sunday 7:45 AM Briefing and Walk-throughs 8:00 AM Judging begins MAS/EXC JWW TIME 2 BEAT MAS/EXC STD OPEN STD NOV STD OPEN JWW NOV JWW Little to Big SITE INFORMATION: All classes will be held in heated/air conditioned building on stall matting (ring size: 70ft x 115ft). Exhibitors and spectators are expected to keep the entire area clean. Anyone witnessed not picking up after their dogs on the trial grounds will be excused from the trial with no entry fees refunded. CRATING: There will be limited crating available. Please be prepared to stack crates or use the elevated crating platforms. X-pens and oversized chairs not allowed. Crates may be left overnight, however, TROCCW, WRKC, Camp Bandy and Bluestem Agility Trial Services, LLC will not be responsible for any lost or damaged items left at the show site. Dogs may not be left overnight. No exhibitor set up before 11:00 am on Friday. Building opens 6:30 am Saturday & Sunday. FOOD: Food and beverages will be available at the show site all three days. 7:45 AM Briefing and Walk-throughs 8:00 AM Judging begins MAS/EXC JWW MAS/EXC STD OPEN STD NOV STD OPEN JWW NOV JWW Big to Little CATALOGS: Running orders will be available online at Full catalogs will be available for sale for $10.00 on the day of the trial, but supplies will be limited. Advanced catalog sales $8.00. Please indicate on your entry form if you would like a catalog. PRIZES AND AWARDS: Ribbons will be awarded to First through Fourth place in each class and height division. Qualifying ribbons will be awarded to those dogs receiving qualifying scores. New title ribbons, Double Q ribbons, MACH and PACH ribbons & bars will also be awarded. Dogs must qualify to receive placement ribbons. Prizes must be claimed the day of the show none will be mailed. VETERINARIAN ON CALL: AMHERST VETERINARY HOSPITAL County Rd KK, Amherst WI Mon, Tues, Thurs, Fri 8am-5pm; Wed 8-7pm; Sat 8am-noon; closed Sun. EMERGENCY VETS OF CENTRAL WISCONSIN Kronenwetter Dr, Mosinee WI Open after hours weekdays and all day weekends & holidays.

4 JUMP HEIGHT DIVISIONS: Owners are responsible for entering the proper height division. Height at Withers Jump Height Regular Classes Jump Height Preferred Classes 11 and under 8 inches 4 inches 14 and under 12 inches 8 inches 18 and under 16 inches 12 inches 22 and under 20 inches 16 inches Over inches 20 inches 26 inch jump height may be entered at the owner s discretion. HEIGHT CARD REQUIREMENT: When filling out the entry form, please designate whether your dog has a valid jump height card or if your dog needs to be measured. Please check the appropriate box so that the Trial Secretary knows whether to include your dog on the list of dogs to be measured. If a measurement is necessary, it is solely the exhibitor s responsibility to have their dog measured prior to running. Exhibitors should have their dog s original, official jump height card or temporary jump height form available at each trial to present upon request. Regulations for Agility Trials, Chapter 2, Section 4. REFUNDS: No entry fees will be refunded if the trial cannot open or be completed by reason of riots, civil disturbances, fire, act of God, public emergency, act of a public enemy, or any other cause beyond the control of the organizing committee. Entry fees shall not be refunded in the event that a dog is absent, disqualified, excused by a judge, or barred from competition by action of the Trial Committee. Entry fee for bitches that come into season or a dog that is injured after the closing date will be refunded (less $12 administrative fee per day) if a veterinarian s certificate is presented to the Trial Secretary prior to the start of judging on the first day of the trial. OBSTACLES: Obstacles will meet the specifications in the current edition of the Regulations for Agility Trials. A break away tire will be used at these trials. DOGS ELIGIBLE TO ENTER: This trial is open to all dogs fifteen (15) months of age or older that are registered with the American Kennel Club or that have AKC Limited Registration, Purebred Alternative Listing/Indefinite Listing Privileges (PAL/ILP) an AKC Canine Partners listing number, or approved Foundation Stock Service (FSS) breeds. Bitches in season, aggressive, blind or deaf dogs or dogs suffering from any deformity, injury or illness which may affect the dog s physical or mental performance are ineligible to participate. Mixed breed dogs that have been listed with AKC Canine Partners may participate provided their listing number has been recorded on the entry form. RINGSIDE: Dogs are not required to be at the trial until the scheduled time of judging. All dogs not needed for further judging are excused. The owner or handler of each dog is solely responsible for having the dog ready at ringside when the class is to be judged. Please help your fellow competitors, the trial workers, and the judge by checking in with the gate steward well ahead of your turn, and being prompt at the line when your turn comes to run. SAFETY AND BEHAVIOR: The safety of the dogs is our primary concern. By entering this trial, exhibitors acknowledge that they are familiar with the rules and regulation of this sport and that their dogs are familiar with and able to perform all obstacles safely. Exhibitors should follow their veterinarians recommendation to assure their dogs are free of internal and external parasites, any communicable diseases, and have appropriate vaccinations. LIABILITY: It is expressly understood that exhibitors alone are responsible for the behavior of their dogs and/or children. Any exhibitor whose dogs and/or children create unnecessary disturbances or repeatedly engage in unsafe or disruptive behavior may, at the discretion of the Trial Committee, be asked to leave the show site. In such cases, no refund of any fees paid will be made. TROCCW, WRKC, Camp Bandy, Bluestem Agility Trial Services, LLC, and their members, agents, etc. will assume no responsibility for any loss, damage or injury sustained by exhibitors or handlers, or to any of their dogs or property, and further assumes no responsibility for injury to children. HOTEL INFORMATION: The following area hotels accept well-behaved people and their pets. Exhibitors must contact hotels directly and identify themselves as having dogs. Some of these hotels do charge an extra fee for dogs. Be sure to verify the dog policy with the hotel of your choice when you make your reservation. Please be a responsible owner and a considerate hotel guest by maintaining a restful atmosphere and cleaning up after your dog. AmericInn, 1501 American Dr, Plover WI $15 charge for length of stay. Comfort Inn of Plover, 1560 American Dr, Plover WI No extra fee. Mention Camp Bandy for special rate. Country Inn, 301 Division St, Stevens Point WI $25 charge for length of stay. Elizabeth Inn, 5246 Harding Ave, Plover WI $25 charge per night La Quinta Inn, 4917 Main St, Stevens Point WI No extra fee. Mention Camp Bandy for discount. Ramada Inn, 110 Grand Seasons Dr., Waupaca WI $12 charge per night. Stay Inn & Suites, 59 Division Street, Stevens Point WI $20 refundable deposit. Overnight RV Parking is available at Camp Bandy. Cost $10 per night. No hookups or facilities. Please pay at the Camp Bandy store. DIRECTIONS TO TRIAL SITE: From North, South and West: From I-39 in Stevens Point, take Hwy 10 East (towards Waupaca) to Lake Road/Amherst Junction Exit. Turn right onto Lake Road. Cross railroad tracks, bear left & continue on Lake Road after first stop sign (Lake Emily will be on your right). Turn left at second stop sign onto Lake Emily Rd. Camp Bandy is on the Left (approximately 5 blocks). From East: Hwy.10 West to Amherst (approximately 10 miles from Waupaca). approximately 10 miles to the County Road B WEST exit. Turn Right onto Cty B. Almost immediately, turn left onto County Road Q. Approx 1 mile down, road makes a 90 degree turn to the left and becomes Main Street. Stay on Main St (Q will turn to the right). Camp Bandy is on the Right just out of town (approximately 3 blocks).

5 OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM Timber Ridge Obed Club of Cent Wisc, Inc Nov 24, 2017 Wisconsin Rapids Kennel Club November 25 & 26, 2017 Opens:10/10/2017 Closes: 11/11/2017 STD JWW T2B FRIDAY SATURDAY SUNDAY ---- Entry Fee: $18.00 per class Make checks payable to: Camp Bandy Mail to: Lorah Marquardt, Event Secretary, 1124 W River Dr, Stevens Point WI IMPORTANT: Carefully read instructions before filling out! ENTRY FEE ENCLOSED Choose Either Regular OR Preferred Classes Circle one jump height, and circle class selections :: Only one selection per class (STD, JWW, FAST, T2B) REGULAR Classes STD NovA JWW NovA FAST NovA T2B T2B NovB Open Exc Master STD PREFERRED Classes NovP OpenP ExcP MasterP PremierP JWW NovP OpenP ExcP MasterP PremierP FAST NovP OpenP ExcP MasterP T2B T2BP Non-Regular Classes International Sweepstakes STD JWW ISC Jump Height - Select: or- Jump Height Same as Regular/Preferred This Dog Needs To Be Measured Yes No SEX HEIGHT AT WITHERS BREED VARIETY CALL NAME AKC NAME (INCLUDE AKC TITLES ONLY) AKC NO Enter Complete Registration # below ILP NO. PAL NO. FOREIGN REG. NO & COUNTRY BREEDER SIRE DAM ACTUAL OWNERS DATE OF BIRTH PLACE OF BIRTH (LIST COUNTRY) OWNERS ADDRESS NEW ADDRESS CITY, STATE ZIP + 4 HANDLER ENTER JR. HANDLER # if applicable Exhibitor or owner MUST sign on the signature line beneath the instructions. AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, AGREEMENT I (we) agree that the club holding this event has the right to refuse 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 dog judged and to win prizes, ribbons, or trophies, I (we) agree to hold the AKC, the event-giving club, their members, 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 parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may 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 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 damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend, and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon 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 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 negligence of the aforementioned parties or any of their employees or agents, or any other persons. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE 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, INTREPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES. INSTRUCTIONS Handlers may opt to enter in a higher height division for all Regular titling classes, but not in a division lower than their proper height division. Dogs entered in the Preferred classes must compete at the required jump height and may not compete in a jump height division higher or lower than their proper height division. All dogs that have not been officially measured for an Agility Jump Height Card may still compete; however, they must be measured by a Judge of record, an Agility Field Representative, or a Volunteer Measuring Official, prior to running. If measured by the Judge of record, that measurement will be valid for this trial or back-to-back trials only. If a measurement is necessary, it is the exhibitor's responsibility to have their dog(s) measured prior to running. Dogs listed in the AKC Canine Partners SM program may be eligible to enter all-breed AKC agility trials at the club s option. These dogs should be listed as All American Dog and must include their AKC number on the entry form and check the AKC No. box. Junior Handlers should enter their Junior Handler number on the front of this form. Should you not have your Junior Handler number, it may be obtained from the American Kennel Club (919) If the 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? 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 the acceptance of this entry, I (we) agree to abide by the rules and regulations of the American Kennel 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 entered is not a hazard to persons or other dogs. This entry is submitted for acceptance on the forgoing representation and agreement. I (we) agree to conduct myself (ourselves) in accordance with all such Rules and Regulations (including all provisions applying to discipline) and to abide by any decisions made in accord with them. SIGNATURE of owner or his agent duly authorized to make this entry. SIGN HERE X Telephone Number: Address: In Case of Emergency - Name: Phone #: New (NOT REQUIRED) AEAGL2 (06/15)

6 OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM Timber Ridge Obed Club of Cent Wisc, Inc Nov 24, 2017 Wisconsin Rapids Kennel Club November 25 & 2, 2017 Opens:10/10/2017 Closes: 11/11/2017 STD JWW T2B FRIDAY SATURDAY SUNDAY ---- Entry Fee: $18.00 per class Make checks payable to: Camp Bandy Mail to: Lorah Marquardt, Event Secretary, 1124 W River Dr, Stevens Point WI IMPORTANT: Carefully read instructions before filling out! ENTRY FEE ENCLOSED Choose Either Regular OR Preferred Classes Circle one jump height, and circle class selections :: Only one selection per class (STD, JWW, FAST, T2B) REGULAR Classes STD NovA JWW NovA FAST NovA T2B T2B NovB Open Exc Master STD PREFERRED Classes NovP OpenP ExcP MasterP PremierP JWW NovP OpenP ExcP MasterP PremierP FAST NovP OpenP ExcP MasterP T2B T2BP Non-Regular Classes International Sweepstakes STD JWW ISC Jump Height - Select: or- Jump Height Same as Regular/Preferred This Dog Needs To Be Measured Yes No SEX HEIGHT AT WITHERS BREED VARIETY CALL NAME AKC NAME (INCLUDE AKC TITLES ONLY) AKC NO Enter Complete Registration # below ILP NO. PAL NO. FOREIGN REG. NO & COUNTRY BREEDER SIRE DAM ACTUAL OWNERS DATE OF BIRTH PLACE OF BIRTH (LIST COUNTRY) OWNERS ADDRESS NEW ADDRESS CITY, STATE ZIP + 4 HANDLER ENTER JR. HANDLER # if applicable Exhibitor or owner MUST sign on the signature line beneath the instructions. AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, AGREEMENT I (we) agree that the club holding this event has the right to refuse 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 dog judged and to win prizes, ribbons, or trophies, I (we) agree to hold the AKC, the event-giving club, their members, 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 parties, and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may 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 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 damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend, and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon 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 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 negligence of the aforementioned parties or any of their employees or agents, or any other persons. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE 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, INTREPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES. INSTRUCTIONS Handlers may opt to enter in a higher height division for all Regular titling classes, but not in a division lower than their proper height division. Dogs entered in the Preferred classes must compete at the required jump height and may not compete in a jump height division higher or lower than their proper height division. All dogs that have not been officially measured for an Agility Jump Height Card may still compete; however, they must be measured by a Judge of record, an Agility Field Representative, or a Volunteer Measuring Official, prior to running. If measured by the Judge of record, that measurement will be valid for this trial or back-to-back trials only. If a measurement is necessary, it is the exhibitor's responsibility to have their dog(s) measured prior to running. Dogs listed in the AKC Canine Partners SM program may be eligible to enter all-breed AKC agility trials at the club s option. These dogs should be listed as All American Dog and must include their AKC number on the entry form and check the AKC No. box. Junior Handlers should enter their Junior Handler number on the front of this form. Should you not have your Junior Handler number, it may be obtained from the American Kennel Club (919) If the 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? 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 the acceptance of this entry, I (we) agree to abide by the rules and regulations of the American Kennel 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 entered is not a hazard to persons or other dogs. This entry is submitted for acceptance on the forgoing representation and agreement. I (we) agree to conduct myself (ourselves) in accordance with all such Rules and Regulations (including all provisions applying to discipline) and to abide by any decisions made in accord with them. SIGNATURE of owner or his agent duly authorized to make this entry. SIGN HERE X Telephone Number: Address: In Case of Emergency - Name: Phone #: New (NOT REQUIRED) AEAGL2 (06/15)