Badger Kennel Club. Saturday, December 15 th & Method of Entry First Received

Transcription

1 Premium List: Event #s- Saturday (# ), Sunday (# ) Show Hours: Saturday and Sunday, 7:00am-7:00pm Badger Kennel Club AKC All-Breed Agility Trial (Licensed by the American Kennel Club) Open to Dogs Enrolled in the AKC Canine Partners Program. Saturday, December 15 th & Sunday, December 16 th, 2018 Classes offered: Saturday--All Levels STD, JWW and FAST & Premier JWW Sunday--All Levels STD, JWW, T2B & Premier STD Canine Sports Zone 3036 Laura Lane, Middleton, WI Each days entries Limited to 350 per day. Method of Entry First Received Entries open October 24, 2018 at 8:00am. Any entries received before this date will be returned. 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. All express mail must be left with no acceptance signature required. Entries close November 28, 2018 at 6:00pm 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. 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 entries with fees (check or money order) payable to BKC to: Lorah Marquardt, BKC Secretary Bluestem Agility Trial Services, LLC 1124 W. River Drive, Stevens Point, WI Questions? Call: (715) or (preferred): ENTRY FEES: $22.00 for the first entry of each dog per day (inc $3.50 AKC recording fee); $16.00 for each additional entry of the same dog/the same day (inc $3.00 AKC recording fee). WAIT LIST FOR WITHDRAWN ENTRIES: A Wait List of a maximum of 25 entries will be maintained to fill openings created by entries withdrawn after the closing date.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 Written notice to withdraw an entry must be received by the Trial Secretary no later than 6pm on Monday, Dec 10, If a withdrawn entry is replaced by a wait listed entry, a full refund will be issued for the withdrawn entry.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. President: Terry Lendved Treasurer: Karen Scott BADGER KENNEL CLUB OFFICERS Vice President: Bryan Conrad Secretary: Pat Smith 5925 Haase Rd Deforest WI VOLUNTEER WORKER SIGN-UP Badger Kennel Club Dec 15 & 16, 2018 Volunteers will receive lunch, snacks & refreshments ONLINE WORKER SIGN UP WILL BE AVAILABLE 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. Name: Address: Phone: Check classes you would be willing to work in (not those you are entering) and jobs you would be willing to do. PLEASE SEE RUNNING ORDER FOR CLASSES OFFERED AND ORDER Board: Gail Jackson, Jennifer Larson, Kim Lohman, Joan Mrkvicka, & Yvonne Slusser Club Website: EVENT COMMITTEE Event Chair: Kelly White, 710 S Main St, DeForest, WI lucygoose100@gmail.com Members: Denine Ackerbauer, Ellen Blitz, Jone Brown, Carrie Knutson, Dawn Christensen Volunteer Coordinator: Jone Brown, autumnacresvizslas@gmail.com TRIAL JUDGE: Zach Davis, 118 N Howard St Apt 515, Baltimore MD zgulaboffdavis@gmail.com Mas/ Exc Std 16-4 Open Std Nov Std Prem Std Mas/ Exc JWW 16-4 Open JWW Nov JWW Prem JWW Mas/Exc FAST Open FAST Nov FAST Time 2 Beat Sat Sun Job: Sat Sun Course Builder Timer Scribe Gate Steward Ring Crew Scribe Sheet Leash Runner

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. Written notice must be given to the Trial Secretary no later than 6pm on Monday, Dec 10, Day to day move-ups will be accepted if received before the close of the trial Saturday, Dec 15, Trial close will be considered to be the awarding of ribbons for the last class on that day. Move-ups will be added to the end of the running order of the class they move up to and 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): Day(s) 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 and START TIMES: Saturday 7:00 am Check in 7:45 am Briefing and Walk-throughs 8:00 am Judging begins MAS/EXC FAST OPEN FAST NOVICE FAST PREMIER STD MAS/EXC STD MAS/EXC JWW OPEN STD NOVICE STD OPEN JWW NOVICE JWW Tall to Small Building opens at 6:30 am on Sat and Sun. Sunday 7:00 am Check in 7:45 am Briefing and Walk-throughs 8:00 am Judging begins TIME 2 BEAT PREMIER JWW MAS/EXC JWW MAS/EXC STD OPEN STD NOVICE STD OPEN JWW NOVICE JWW Small to Tall SITE INFORMATION: All classes will be held in a heated building on field turf with rubber infill. Ring size: 132 ft x 80 ft. 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. No smoking in any of the buildings. CRATING: There is plenty of crating at this site, please bring a ground cover for under your crates. The crating area is climate controlled. Crates may be left overnight; however, Badger Kennel Club, Canine Sports Zone 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. PARKING: There is ample parking available. RV overnight parking is available at the trial site. Cost for motorhomes/campers $10 per night for no electrical hookups. $25/night for electrical hookups. Electrical hookups are limited and are by first request/payment basis. Please to check availability & hold: Jessica@CanineSportsZone.com. Checks payable to Canine Sports Zone. CATALOGS: Running orders will be available online. Full catalogs will be available for sale for $10 on the day of the trial, but supplies will be limited. Advanced catalog sales $7. PRIZES AND AWARDS: Qualifying ribbons will be awarded to those dogs receiving qualifying scores. Rosettes will be awarded for first through fourth place in each jump height division for Excellent, Novice and Open levels. New title ribbons, double Q ribbons and MACH & PACH rosettes and bars will also be awarded. Prizes must be claimed the day of the show -- none will be mailed. FOOD: Food and beverages will be provided for workers. Food for non-workers will not be available for purchase. There are many restaurants within 5 minutes of the show site.

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 fee will be refunded if the Trial cannot open or be completed by reason of riots, civil disturbances, fire, an act of God, public emergency, act of a public enemy, or any other cause beyond the control of the organizing committee. No entry fee will be refunded in the event a dog is absent, disqualified, excused, or barred from competition by the action of the Trial Committee. Bitches in season are not permitted to compete in Agility Trials. Entry fees for bitches that come into season will be refunded by mail, minus $12 per day fee. Entry fees for dogs that are injured after the closing date will be refunded by mail, minus $12 per day fee, if a veterinarian's certificate is presented to the trial secretary. Refunds must be requested prior to the start of judging. Errors on entry forms are the owner's responsibility and no entry fee will be refunded in the event of such errors or cancellation of entries after the trial has closed. OBSTACLES: Obstacles will meet the specifications in the current edition of the Regulations for Agility Trials. Electronic timing, rubberized contacts and weave poles with 24 spacing will be used. DOGS ELIGIBLE TO ENTER: This trial is open to all dogs 15 months of age or older that are registered with the American Kennel Club, or are registerable breeds that have obtained an AKC ILP or PAL number. Bitches in season, aggressive, blind dogs or dogs suffering from any deformity, injury or illness which may affect the dog s physical or mental performance are ineligible to participate. Dogs that have been listed with AKC Canine Partners may participate provided their listing number has been recorded on the entry form and the trial-giving club is offering the optional mixed breed classes RINGSIDE: Dogs not required at the trial until the scheduled time of judging. 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. In case of conflicts, the Standard ring will take precedence all weekend. 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 or external parasites, any communicable diseases, and have appropriate vaccinations. 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. Comfort Suites Baymont 1253 John Q Hammons Drive Madison, WI 8102 Excelsior Dr Madison, WI (608) (608) La Quinta Inn & Suites Staybridge Suites 5217 East Terrace Drive Madison, WI 7790 Elmwood Avenue Middleton, WI (608) DIRECTIONS: Canine Sports Zone 3036 Laura Lane,Middleton, WI (GPS Coordinates: 43 06'25.3"N 89 30'52.2"W) ' From the North: Take the US-12 south toward Madison. Take the Airport Rd exit (EXIT 250) toward Century Ave/County Hwy M. Turn left onto Airport Rd. Turn right onto Laura Ln. Continue to 3036 Laura Ln on the right. From the South: I-90 W toward Rockford/ I-294 N/Milwaukee. Merge onto US-12 W/W Beltline Hwy W via EXIT 142A on the left toward Madison. Take the Parmenter St exit, EXIT 251B. Enter the US-12 Bus E/Parmenter St roundabout. Turn slight right onto Parmenter St/US-12 Bus W. Turn left onto Donna Dr (Culver s). Turn right onto Laura Ln Laura Ln is on the left. From the East: From Milwaukee take I-94 West. Keep left to take WI-30 toward Madison/Janesville. Merge onto US-12 W/W Beltline Hwy W via EXIT 142A toward Madison. Take the Parmenter St exit, EXIT 251B. Enter the US-12 Bus E/Parmenter St roundabout. Turn slight right onto Parmenter St/US-12 Bus W. Turn left onto Donna Dr (Culver s). Turn right onto Laura Ln Laura Ln is on the left. VETERINARIAN ON CALL: Veterinary Emergency Service 1612 N. High Point Rd Ste 100, Middleton, WI (608) 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. Badger Kennel Club, Bluestem Agility Trial Services, LLC, Canine Sports Zone, their members, agents, etc. will assume no responsibility for any loss, damage or injury sustained by exhibitors or handlers, their dogs or property, and further assumes no responsibility for injury to children.

5 OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM Badger Kennel Club December 15 & 16, 2018 Opens:10/24/2018 Closes:11/28/2018 Standard Jumpers FAST T2B Premier Saturday STD Sunday JWW Entry Fee: 1st run $22; $16 each additional run, same day Make checks payable to: BKC 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 SEX HEIGHT AT WITHERS This Dog Needs To Be Measured Yes No 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 Badger Kennel Club December 15 & 16, 2018 Opens:10/24/2018 Closes:11/28/2018 Standard Jumpers FAST T2B Premier Saturday STD Sunday JWW Entry Fee: 1st run $22; $16 each additional run, same day Make checks payable to: BKC 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 SEX HEIGHT AT WITHERS This Dog Needs To Be Measured Yes No 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)