MidAtlantic Working Dog Club

Entry and Waiver Form

BH [  ] TR 1 [  ] TR 2 [  ]  TR 3 [  ]  OB 1 [  ]  OB 2 [  ] OB 3 [  ]  SchH 1 [  ] SchH 2 [  ] SchH 3 [  ]

Name of Handler: ____________________________________________________________ 

Address: ___________________________________________________________________

Phone: __________________________________ Email: ____________________________

USA Member #: __________________________ Exp. Date: _________________________

Name of Dog: _________________________________________ Breed: _______________

Date of Whelp: ____________  Date & Club Where Handler Earned Bh: _________________

Sex:      Male [ ]            Female [ ]                Tattoo/Microchip #: ________________________

Present Titles: _________________________________     H.O.T. ?      (circle)     YES       NO

Scorebook #: ___________________________     Registration: _______________________

Owner Name and Address (if different than Handler): ________________________________

_________________________________________________ Phone: ___________________

Entry fee: BH, OB, TR  $45; SchH 1,2,3  $60   Deadline for entries is November 7, 2008. No Refunds.  For entries postmarked after deadline, include $10 late fee.  All information above must be completed (n/a if not applicable), be identical to that in the dog’s scorebook, and Waiver must be signed.            

Release and Waiver

It is understood that every dog at this event will at all times be in the care and control of the dog’s handler. It is further understood that the undersigned agrees to be fully responsible for the actions of that dog, while on the show grounds. I agree to hold the Mid Atlantic Working Dog Club, United Schutzhund Clubs of America, American Hydro, as well as their members, officers, directors, and all property owners harmless for injury which may have been caused directly or indirectly to any person or thing by any act of my dog(s) while on the show premises. I hereby assume all responsibility and liability for such claims.

 Owner/Handler Signature: _______________________________________________________

Print Name: ________________________________________  Date: _____________________

Make all checks payable to Mid Atlantic Working Dog Club.  Contact us for mailing address.