BCDC c/o Barbara Wirkowski 16 Clarissa Drive Middletown NJ 07748 Event #'s: 2015121219 (Sat Rally), 2015121218 (Sat Obedience) & 2015121217 (Sun Obed) No hand deliveries. No signature required on overnight deliveries. ENTRIES OPEN: AUGUST 1, 2015. ENTRIES CLOSE: 12:00 NOON, WEDNESDAY, October 21, 2015 at the Trial Secretary s Office or when the combined judging time limit is reached, after which time entries cannot be accepted, cancelled or substituted except as provided for in Chapter 11, Section 6 of the Dog Show Rules. A wait list will be established to fill openings created by entries that are withdrawn prior to the Closing Date. PREMIUM LIST Saturday, November 7, 2015 Rally & Obedience Trials Sunday, November 8, 2015 Obedience Trial All Entries Sat & Sun limited by time, no class limits BAYSHORE COMPANION DOG CLUB INC. (Unbenched - Indoors) (Licensed by the American Kennel Club) UP FRONT FARM & DOG TRAINING CENTER 128 Arneytown-Hormerstown Road, Allentown NJ 08501-1414 SHOW HOURS: 7:00 A.M. to 6:00 P.M. both days. Judging begins at 8:00 A.M. TRIAL IS OPEN TO MIXED BREED DOGS ENROLLED IN THE AKC CANINE PARTNERS PROGRAM No Overnight Parking - Free Parking - No Admission Fee, No RV's Allowed MAIL ALL ENTRIES WITH FEES TO: Barbara Wirkowski, Trial Secretary 16 Clarissa Drive, Middletown NJ 07748 American Kennel Club Certification Permission is granted by the American Kennel Club for the holding of this event under American Kennel Club Rules and Regulations. James P. Crowley, Secretary
2015 OFFICERS OF THE BAYSHORE COMPANION DOG CLUB, INC. President Kathleen Rupprecht Vice President.....Susan Soviero Treasurer...Mary Kosenski Secretary...Paul Mount 7 William Street, Matawan NJ 07747 BOARD OF DIRECTORS Wendy Boyce, Carollyn Carson, Jo Lesko, Denise Marden, Marisa Schmidt Charles Dilorio Trial Chair 151 Main Avenue Brick, NJ 08724 732-648-9346 oreorocky@earthlink.net Barbara Wirkowski Trial Secretary 16 Clarissa Drive Middletown, NJ 07748 7332-610-5317 barbara_wirkowski@comcast.net Chief Ring Steward: Vera Zumba TRIAL COMMITTEE Teryl Lebkuecher Assistant Trial Chair 3799 Herbertsville Road Wall, NJ 08724 732-539-6802 onedobe@aol.com Hospitality: Laura Kelly Grounds/Parking: Bob Ferrara Veterinarian on Call: North Star Vets Emergency Center 315 Robbinsville-Allentown Road Robbinsville, NJ 08691 609-259-8300 NOTICE TO EXHIBITORS ENTRIES & FEES: $30.00 for the first entry of each dog (including $3.00 AKC Event Service Fees & $.50 AKC Recording Fee) & $25.00 for each additional entry of the same dog PER TRIAL. CLOSING DATE FOR ENTRIES: 12:00 NOON, Wednesday, October 21, 2015 (at the Trial Secretary s address) after which time entries cannot be accepted, cancelled or substituted except as provided for in Chapter 11, Section 6 of the Dog Show Rules. An AKC RECORDING FEE of $.50, and an AKC Event Service Fee of $3.00 will be required for each dog entered at any Licensed or Member Club Show, Obedience Trial or Tracking Test. If a dog is entered in more than one class in one of these events, the AKC Recording Fee and Service Fee is to be collected on the first entry only (AKC Rules Applying to Dog Shows, Chapter 11, Section 2). All Recording Fees are paid to the AKC. MAIL ALL ENTRIES WITH FEES TO: BARBARA WIRKOWSKI, 16 CLARISSA DRIVE, MIDDLETOWN N.J. 07748. No hand delivery of entries. Overnight deliveries must have NO SIGNATURE REQUIRED. Acknowledgement of entries will be made as soon as practicable. If no acknowledgement is received by the exhibitor within a reasonable time, please notify the Trial Secretary at 732-610-5317. Entries not on an official AKC entry form, or photocopies of an entry form without the agreement will not be accepted. Entries received without fees or a signature, will not be accepted. No entry shall be made and no entry shall be accepted which specifies any conditions as to its acceptance. MAKE ALL CHECKS AND MONEY ORDERS PAYABLE TO: BAYSHORE COMPANION DOG CLUB INC. (BCDC). Trial Secretary assumes no responsibility for cash sent through the mail. Canadian exhibitors make fees payable in U.S. FUNDS RETURNED CHECKS do not constitute a valid entry fee. The Trial Secretary will add a $30.00 collection fee to the amount of each returned check. Subsequent returned checks from the same exhibitors may result in their being put on a CASH ONLY basis. Entries not on an official AKC entry form, or photocopies of an entry form without the agreement will not be accepted. ENTRY FEES shall not be refunded in the event that a dog is absent, disqualified, excused by Veterinarian or Judge, or barred from competition by action of the Show Committee. If because of riots, civil disturbance or other acts beyond the control of the management it is impossible to open or complete the show, no refund of entry fees will be made. EXTREME WEATHER CONDITIONS, such as, but not limited to snowstorms, hurricanes, lightening, extreme heat must be considered for the health and safety of the dogs, exhibitors and spectators. The well-being of dogs, exhibitors and spectators is of paramount importance and, in the event if is necessary to cancel or stop the show before completion, no refund of entry fees will be made. If cancellation is decided before the event, notification will be recorded on the BCDC phone (732) 460-1446 and posted on the club website www.bayshoredogclub.org. BITCHES IN SEASON are not permitted to compete. The Club will refund the entry fee for bitches unable to compete for that reason. The Trial Secretary must be notified of such claim for refund either 30 minutes prior to the start of the first class in the trial or by letter postmarked by October 21, 2015 or earlier. ERRORS ON ENTRY FORMS. Owners are responsible for errors in making out entry forms, whoever may have made such errors, and no entry fee will be refunded in event of such errors or cancellation of entries after the published closing date. NO REFUND FOR DUPLICATE ENTRIES. We will make every effort to find all duplicate entries, but if a dog has been processed, no refund will be made. DOGS MAY ARRIVE any time prior to their scheduled time of judging. JUDGES WILL NOT WAIT FOR ANY DOG HOLDING UP A CLASS. Owners or agents alone are responsible for the presence of their dogs in the ring when their class is called to be judged. ALL DOGS must be on leash or confined to a crate except when being judged. Parents must be responsible for their children at all times. DECLINATION OF ENTRIES/REMOVAL OF DOG: The show committee may refuse to admit or may remove any dog on account of disease, viciousness, or other cause, and no one shall have any claim or recourse against the show-giving club or any official thereof. THE BAYSHORE COMPANION DOG CLUB, INC. WILL NOT BE HELD RESPONSIBLE FOR ANY ACCIDENT that may occur to any person, animal, property or vehicle. The exhibitors shall hold the Show Committee harmless and indemnify it against any legal proceeding arising from any accident.
AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, www.akc.org 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 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 there from, 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 the negligence of the aforementioned parties or any of their employees, 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, INTERPRETATION 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 1. (Variety) if you are entering a dog of breed in which there are varieties for show purposes, please designate the particular variety you are entering, i.e., Cocker Spaniel (solid color black, ASCOB, parti-color), Beagles (not exceeding 13 in., over 13 in. but not exceeding 15 in.), Dachshunds (longhaired, smooth, wirehaired), Collies (rough, smooth), Bull Terriers (colored, white), Manchester Terriers (standard, toy), Chihuahuas (smooth coat, long coat), English Toy Spaniels (King Charles and Ruby, Blenheim and Prince Charles), Poodles (toy, miniature, standard). 2. The following categories of dogs may be entered and shown in Best of Breed competition: Dogs that are Champions of Record and dogs which, according to their owners records, have completed the requirements for a championship, but whose championships are unconfirmed. The showing of unconfirmed Champions in Best of Breed competition is limited to a period of 90 days from the date of the show where the dog completed the requirements for a championship. 3. (Event Class) Consult the classification in this premium list. If the event class in which you are entering your dog is divided, then, in addition to designating the class, specify the particular division of the class in which you are entering your dog, i.e., age division, color division, weight division. 4. 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 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 name. State on entry form whether transfer application has been mailed to the AKC. (For complete rules, refer to Chapter 11, Section 3.) If this entry is for Junior Showmanship, please give the following: Jr. Handler ID # Jr s Date of Birth The above number MUST be included. Should you not have your Junior Handler number, this may be obtained from the American Kennel Club. (Phone) 919-816-3776. ADDRESS: CITY: STATE: ZIP: If Jr. Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Jr. Handler to the owner: By signing the entry form, we certify that the Junior Showman does not now, and will not at any time, act as an agent/handler for pay while continuing to compete in Junior Showmanship FRONT AND BACK OF FORM MUST BE INCLUDED JUDGES & ASSIGNMENTS: Jean Nocilly, PO Box 315, Cheswold, DE 19936-0315 315-246-1813 Saturday: Obedience Beginner Novice A & B, Graduate Novice, Graduate Open Rally: Novice A & B, Advanced A & B, Excellent A & B Sunday: Obedience: Novice A, Utility A & B Kathleen Walker, 499 Sergeantsville Rd., Flemington NJ 08822-2712 Saturday: Obedience: Novice A & B, Open A & B, Utility A & B Sunday: Obedience: Novice B, Open A, Open B Jump Heights will be in DESCENDING (tall to small) order for all trials. Regular Obedience Classes - RIBBONS First Place...Blue Rosette Second Place..Red Rosette Third Place.....Yellow Rosette Fourth Place....White Rosette Highest Scoring Dog in Trial..Blue & Gold Rosette Open B and Utility Combined..Blue & Green Rosette Highest Combined Score in Open B and Utility $50.00 Highest Scoring Dog in Trial..$100.00 Regular Rally Classes - RIBBONS First Place...Blue Rosette Second Place..Red Rosette Third Place.....Yellow Rosette Fourth Place....White Rosette Highest Combined Score from Advanced B & Excellent B $50.00 Dark Green Qualifying Score Ribbon offered to all dogs receiving qualifying scores in Regular and Non-Regular Obedience classes and Rally Classes. Those dogs earning a new title at our Trials will receive a New Title Ribbon. All awards must be claimed at the trials. None will be mailed. Transfers will be accepted after the Trial Closing Date. Transfers are due to the Trial Secretary at least 30 minutes before the start of the trial. Transfers can be sent through regular mail or e-mail and should include the following information: Owner Name, Dog s Registered Name, Dog s AKC Registration #, Class moving from, Class moving to. Due to Judging Limits, we cannot guarantee that all requested Transfers can be accommodated.
ROUTES TO THE SHOW From the New Jersey Turnpike, Exit 7 - Take Route 206 North to Route 528 (Crosswicks Road) and turn right onto Route 528. In approximately 6 miles, Route 528 turns right. DO NOT TURN BUT CONTINUE STRAIGHT on Route 664. In about 2 miles, make left turn onto Arneytown-Hornerstown Road. Show site is approximately 1.9 miles on the right. From the Garden State Parkway & Interstate Route 195: Take exit 98 from Garden State Parkway to I-195 West. Take exit 16 from I-195 to Route 537 West. Go 6.8 miles then make right onto Mill Stream Road. Go 1.6 miles and turn left onto Arneytown-Hornerstown Road. Show Site is approximately 1.9 miles on right. MOTELS WITHIN 30 MINUTES (Please check rates and availability) You are responsible for any damage you or your dogs do on the show and/or motel grounds. Candlewood Suites Bordentown-Trenton, 200 Rising Sun Road, Bordentown NJ... 609-291-1010 Quality Inn East Windsor, 351 Franklin Street, Windsor NJ...609-448-7399 Budget Inn Wrightstown, 2841 Monmouth Rd. Wrightstown NJ...609-723-1372 Red Carpet Inn & Suites Wrightstown, 39 Georgetown Road, Wrightstown NJ...609-723-1372 Days Inn Bordentown, 1073 Rt 206 North, Bordentown NJ...609-298-6100 Please check with hotel when making a reservation for their specific pet policy and fees, if any. Minimal crating space available. No overnight crating. Un-entered dogs NOT allowed in building. Food is NOT available on site. Feel free to bring your own refreshments. Please provide your own chairs and crates. No smoking allowed in the building. A photographer will be available. OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM Bayshore Companion Dog Club, Inc. Event #s: 2015121218 & 2015121217- All Breed Obedience Trials Saturday & Sunday, November 7 & 8, 2015 Up Front Farm & Dog Training Center, 128 Arneytown-Hornerstown Rd, Allentown NJ 08501 ENTRY FEES PER TRIAL: $30.00 for each dog entered ($30.00 Trial Entry includes $3.00 AKC Event Service Fee & $.50 AKC Recording Fee). OPEN B/UTILITY B ENTRIES ONLY: $30.00 FOR FIRST ENTRY and $25.00 FOR EACH ADDITIONAL ENTRY OF EACH DOG. CLOSING DATE:12:00 NOON, Wednesday, October 21, 2015 (at Trial Secretary s Address) after which time entries cannot be accepted, cancelled or substituted except as provided for in Chapter 11, Section 6 of the Dog Show Rules. Mail Entries to: Barbara Wirkowski, 16 Clarissa Drive, Middletown NJ 07748. Payable to BCDC. 11/7/2015 (Saturday) Total Entry Fees Enclosed: $ 11/8/2015 (Sunday) Total Entry Fees Enclosed: $ IMPORTANT: Read Carefully the Instructions on the Reverse Side Before Filling Out. Numbers in parenthesis indicate sections of the instructions relevant to the information needed. PLEASE PRINT BREED VARIETY (1) SEX OBEDIENCE TRIAL CLASS (Circle One) Nov A Nov B Open A Open B Utility A Utility B Beg Nov A Beg Nov B Grad Nov Grad Open ADDITIONAL CLASSES FULL NAME OF DOG Enter Number Here AKC REG NO. AKC LITTER NO. ILP NO. FOREIGN REG NO.& COUNTRY BREEDER SIRE DAM ACTUAL OWNERS (4) OWNERS ADDRESS NAME OF JR HANDLER (See Back) AND NUMBER (Please Print) DATE OF BIRTH OBED JUMP HEIGHT PLACE OF USA CANADA FOREIGN BIRTH Do not print the above in catalog CITY STATE ZIP NAME OF OWNERS AGENT (if any) AT THE SHOW 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 show, obedience trial and/or agility trial, and by any additional rules and regulations appearing in the premium list for this show, obedience trial and/or agility trial, 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 foregoing representation and agreement. SIGNATURE of owner or his agent Duly authorized to make this entry (Must be signed here) TELEPHONE # E-MAIL:
AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, www.akc.org 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 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 there from, 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 the negligence of the aforementioned parties or any of their employees, 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, INTERPRETATION 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 1. (Variety) if you are entering a dog of breed in which there are varieties for show purposes, please designate the particular variety you are entering, i.e., Cocker Spaniel (solid color black, ASCOB, parti-color), Beagles (not exceeding 13 in., over 13 in. but not exceeding 15 in.), Dachshunds (longhaired, smooth, wirehaired), Collies (rough, smooth), Bull Terriers (colored, white), Manchester Terriers (standard, toy), Chihuahuas (smooth coat, long coat), English Toy Spaniels (King Charles and Ruby, Blenheim and Prince Charles), Poodles (toy, miniature, standard). 2. The following categories of dogs may be entered and shown in Best of Breed competition: Dogs that are Champions of Record and dogs which, according to their owners records, have completed the requirements for a championship, but whose championships are unconfirmed. The showing of unconfirmed Champions in Best of Breed competition is limited to a period of 90 days from the date of the show where the dog completed the requirements for a championship. 3. (Event Class) Consult the classification in this premium list. If the event class in which you are entering your dog is divided, then, in addition to designating the class, specify the particular division of the class in which you are entering your dog, i.e., age division, color division, weight division. 4. 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 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 name. State on entry form whether transfer application has been mailed to the AKC. (For complete rules, refer to Chapter 11, Section 3.) If this entry is for Junior Showmanship, please give the following: Jr. Handler ID # Jr s Date of Birth The above number MUST be included. Should you not have your Junior Handler number, this may be obtained from the American Kennel Club. (Phone) 919-816-3776. ADDRESS: CITY: STATE: ZIP: If Jr. Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Jr. Handler to the owner: By signing the entry form, we certify that the Junior Showman does not now, and will not at any time, act as an agent/handler for pay while continuing to compete in Junior Showmanship FRONT AND BACK OF FORM MUST BE INCLUDED OFFICIAL AMERICAN KENNEL CLUB ENTRY FORM Bayshore Companion Dog Club, Inc. Event #:2015121219 - All Breed Rally Trial Saturday, November 7, 2015 Up Front Farm & Dog Training Center, 128 Arneytown-Hornerstown Rd, Allentown NJ 08501 ENTRY FEES PER TRIAL: $30.00 for each dog entered ($30.00 Trial Entry includes $3.00 AKC Event Service Fee & $.50 AKC Recording Fee). Advanced B/Excellent B entries only: $30 for 1st entry and $25 for each additional entry of each dog. CLOSING DATE:12:00 NOON, Wednesday, October 21, 2015 (at Trial Secretary s Address) after which time entries cannot be accepted, cancelled or substituted except as provided for in Chapter 11, Section 6 of the Dog Show Rules. Mail Entries to: Barbara Wirkowski, 16 Clarissa Drive, Middletown NJ 07748.Payable to BCDC. 11/7/15 (Saturday Rally Trial) Total Entry Fees Enclosed: $ IMPORTANT: Read Carefully the Instructions on the Reverse Side Before Filling Out. Numbers in parenthesis indicate sections of the instructions relevant to the information needed. PLEASE PRINT BREED VARIETY (1) SEX RALLY TRIAL CLASS (Circle One) Nov A Nov B Adv A Adv B EXC A EXC B ADDITIONAL CLASSES FULL NAME OF DOG Enter Number Here AKC REG NO. AKC LITTER NO. ILP NO. FOREIGN REG NO.& COUNTRY BREEDER SIRE DAM ACTUAL OWNERS (4) OWNERS ADDRESS RALLY JUMP HEIGHT 4" 8" 12" 16" NAME OF JR HANDLER (See Back) AND NUMBER (Please Print) DATE OF BIRTH PLACE OF USA CANADA FOREIGN BIRTH Do not print the above in catalog CITY STATE ZIP NAME OF OWNERS AGENT (if any) AT THE SHOW 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 show, obedience trial and/or agility trial, and by any additional rules and regulations appearing in the premium list for this show, obedience trial and/or agility trial, 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 foregoing representation and agreement. SIGNATURE of owner or his agent Duly authorized to make this entry (Must be signed here) TELEPHONE # E-MAIL: