Premium List Event #s- Saturday (#2015178401), Sunday (#2015178402) K-9 Obedience Training Club of Menomonee Falls, Falls, Wisconsin AKC All-Breed Agility Trial (Licensed by the American Kennel Club) Open to Dogs Enrolled in the AKC Canine Partners Program. . Saturday, January 31st & Sunday, February 1st, 2015 Classes offered (all levels, both days): Standard, Jumpers with Weaves & T2B Trial Site: Think Pawsitive LLC 2485 Commerce Dr New Berlin, WI 53051 Each days entries Limited to 660 runs. Method of Entry—Random Draw Entries open: Wednesday, December 3, 2014 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. Draw Period Closes: Friday, January 2, 2015 at 5:00pm Draw Date: Friday, January 2, 2015 at 6:00pm Draw Location: 1124 W River Dr, Stevens Point, WI 54481 Entries close Friday, January 16, 2015 at 6:30pm 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: Saturday and Sunday, 7:00am-7:00pm 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. Mail entries with fees (check or money order) payable to K-9 OTC to: Lorah Marquardt, Event Secretary Bluestem Agility Trial Services, LLC 1124 W. River Drive, Stevens Point, WI 54481 Questions? Call: (715) 342-0679 or Email (preferred): [email protected] 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). VOLUNTEER WORKER SIGN-UP K9 OTC Jan 31 & Feb 1, 2015 Please be generous with your time. Volunteers will receive lunch & a drink. Name: EMAIL: Address: (if no email) WAIT LIST FOR WITHDRAWN ENTRIES: A Wait List of a maximum of 25 entries will be maintained to fill openings created by entries withdrawn after the closing date.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, January 26, 2015. 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. K-9 OTC CLUB OFFICERS President: Barb Adams Treasurer: Monica Brammer Phone: I will sign up online. Link will be emailed to all entrants as soon as it is available. (Form must be included with entry to be considered for a worker slot in the random draw.) Check classes entered and write in jump height divisions: Vice President: Juli Cepulis Secretary: Shirley Wolcyk 11421 W Freistadt Rd Mequon WI 53097 Saturday Class STD Board: Chris Bach, Dick Bahr, Dr Kaye Krueger, Clif Sanders Club Website: www.k9otc.com JWW EVENT COMMITTEE Trial Chair: Barbara Szesterniak, [email protected], 262-227-3403 4515 Edington Lane, Brookfield, WI 53045 Members: Dave Bate, Sherry Kelber, John Schroepfer, Debbie Seder, Janis Shogren Volunteer Coordinator: Debbie Seder, 262-246-4895, [email protected] TRIAL JUDGES: Terry Elger, 3439 N 79th St, Milwaukee WI 53222 Classes: Saturday: Standard; Sunday: Jumpers, T2B Joan Mullen, W186 N7064 Marcy Rd, Menomonee Falls WI 53051 Classes: Saturday: Jumpers, T2B; Sunday: Standard Height Sunday Class Height Exc/Mas Open Novice Exc/Mas Open Novice T2B Check jobs you would be willing to work: Job: Sat Sun Job: Course Builder Gate Steward Timer Ring Crew Scribe Leash Runner Transcribe Scribe Sheet Runner Sat Sun Please note any additional information: Thanks for volunteering—Your help is greatly appreciated! Contact volunteer coordinator Debbie Seder, 262-246-4895, [email protected] with any questions. RUNNING ORDER and START TIMES: 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, Jan 26, 2015. Day to day move-ups will be accepted if received before the close of the trial Saturday, Jan 31, 2015. 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. E-mailed requests accepted as long as all information is included. -----------------------------------------------------------------------------------------------AKC Registered Name: _________________________________________ AKC Registration #: ___________________________________________ Breed: ____________________________ Call name: _________________ Owner(s): ____________________________________________________ 4” 8” 12” 16” 20” 24” STD Move to: Open Exc Mas Move to: Open P Exc P Mas P Move to: Open Exc Mas Open P Exc P Mas P STD Pref JWW JWW Pref Move to: Sunday 7:00 AM Check-in 7:45 AM General Briefing 7:00 AM Check-in 7:45 AM General Briefing Ring 1 Ring 1 8:30 AM STANDARD: 8:30 AM STANDARD: Excellent/Master 26, 24 / 20 / 16 / 12, 8, 4 Open -Tall to Small Novice - Tall to Small Excellent/Master 26, 24 / 20 / 16 / 12, 8, 4 Open - Tall to Small Novice - Tall to Small Ring 2 Ring 2 8:00 AM T2B Tall to Small 8:00 AM T2B Tall to Small JUMPERS W/ WEAVES to follow Excellent/Master 16 / 12, 8, 4 / 26, 24 / 20 Open - Tall to Small Novice -Tall to Small JUMPERS W/ WEAVES to follow Excellent/Master 16 / 12, 8, 4 / 26, 24 / 20 Open - Tall to Small Novice - Tall to Small Please Note: Walk throughs to be split as shown, or where appropriate based on class size, to insure adequate time for all. In case of conflict, the Standard ring will take precedence. SITE INFORMATION: All classes will be held indoors on artificial turf. Ring size is 73’ x 115’. 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. Please respect neighboring businesses by not exercising dogs on their property. Building will open at 6:30 am Saturday and Sunday. VIEWING: For safety reasons, chairs are not allowed in the ring area. Sitting is not allowed on the stairs near the rings, nor are dogs permitted to stand or wait on the stairs. Day(s) Move-up requested for: Height Division: Saturday CRATING: Ample indoor crating space is available in multiple rooms on two levels. Much of the crating space is on the 2nd floor. First floor crating space for those handlers physically unable to climb stairs can be secured in advance. Please contact Trial Chair Barbara Szesterniak, [email protected], 262-227-3403. Crates may be left overnight; however, K-9 OTC, Think Pawsitive, LLC 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 in several lots. Watch for signs. No street or overnight parking allowed. CATALOGS: Running orders will be available online. Full catalogs will be available for sale for $12.00 on the day of the trial, but supplies will be limited. Advanced catalog sales $10.00. Please indicate on your entry form if you would like a catalog. PRIZES AND AWARDS: Rosettes will be awarded to Novice and Open and ribbons to Excellent for 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, PAX ribbons, MACH & PACH ribbons and bars will also be awarded. Dogs must qualify to receive placement ribbons. A dog toy will be offered for each dog entered in the trial. Prizes must be claimed the day of the show -- none will be mailed. 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 22” 24 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 30 min prior to the start of judging that day. 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 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. Dogs that have been listed with AKC Canine Partners may participate provided their listing number has been recorded on the entry form and the trialgiving 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. 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. K-9 Obedience Training Club, Bluestem Agility Trial Services, LLC, Think Pawsitive, LLC, 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. 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. 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. La Quinta Inn & Suites 15300 West RockRidge Rd New Berlin, WI Phone: (262) 717-0900 La Quinta Inn & Suites 20391 West Bluemound Rd Brookfield, WI Phone: (262) 782-9100 Super 8 2510 Plaza Ct Waukesha, WI Phone: (262)786-6015 Extended Stay America 2520 Plaza Ct Waukesha, WI Phone: (262)798-0217 DIRECTIONS: Think Pawsitive 2485 Commerce Dr. New Berlin, WI 53051 www.thinkpawsitivedog.com GPS coordinates: N42° 59.972', W088° 07.180' From the North: Take US-41 S toward MILWAUKEE. Merge onto I-94 W via EXIT 38B toward MADISON. Take the MOORLAND RD SOUTH exit, EXIT 301A.Merge to S. MOORLAND RD/CR-O S. Turn RIGHT onto W LINCOLN AVE. Take the 2nd LEFT onto S COMMERCE DR. 2485 S COMMERCE DR is on the RIGHT. From the South: Take I-94 W/US-41N toward MILWAUKEE. Merge onto I-43 S via EXIT 316 on the LEFT toward MADISON/FOND DU LAC. Take the CR-O/MOORLAND RD exit, EXIT 57. Merge onto SMOORLAND RD/CR-O N toward BELOIT RD EAST. Turn LEFT onto W LINCOLN AVE. Take the 2nd LEFT onto S COMMERCE DR. 2485 S COMMERCE DR is on the RIGHT. From the West: Take I-94 E. Take the MOORLAND RD exit, EXIT 301A-B. Keep RIGHT at the fork to go on S MOORLANDRD/CR-O S. Turn RIGHT onto W LINCOLN AVE. Take the 2nd LEFT onto S COMMERCE DR.2485 S COMMERCE DR is on the RIGHT. VETERINARIAN ON CALL: Wisconsin Veterinary Referral Center 360 Bluemound Road Waukesha, WI 53188 Tel: 866-542-3241 OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM K-9 Obedience Training Club of Menomonee Falls AGREEMENT Jan 31 & Feb 1, 2015 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. Opens:12/3/2014 ● Draw:1/2/2015 ● Closes:1/16//2015 SATURDAY SUNDAY BOTH DAYS Standard Jumpers T2B Daily Entry Fee: 1st run $22; $16 each additional run Make checks payable to: K-9 OTC Mail to: Lorah Marquardt, Event Secretary, 1124 W River Dr, Stevens Point WI 54481 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 PREFERRED Classes 8” 12” 16” 20” 24” 26” STD Nov A Nov B Open Exc Master 4” 8” 12” 16” 20” STD NovP OpenP ExcP MasterP JWW Nov A Nov B Open Exc Master JWW NovP OpenP ExcP MasterP FAST Nov A Nov B Open Exc Master FAST NovP OpenP ExcP MasterP T2B T2B T2B T2BP Non-Regular Classes International Sweepstakes ISC Jump Height - Select: 14” 18” 26” -or- □ □ □ This Dog Needs To Be Measured BREED □Yes □No □STD □JWW □Jump Height Same as Regular/Preferred SEX HEIGHT AT WITHERS VARIETY CALL NAME Enter Complete Registration # below AKC® NO PAL NO. □ FOREIGN REG. NO & COUNTRY BREEDER DATE OF BIRTH 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 PartnersSM 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. ___________________________________________________________________________________________________ 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. PLACE OF BIRTH (LIST COUNTRY) □ SIRE DAM SIGNATURE of owner or his agent duly authorized to make this entry. ACTUAL OWNERS OWNERS ADDRESS 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. 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) 233-9767. 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? _____________________________________________ AKC® NAME (INCLUDE AKC TITLES ONLY) □ ILP NO. □ AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, www.akc.org. SIGN HERE NEW ADDRESS X ______________________________________________________ Telephone Number: CITY, STATE ZIP + 4 □New Email Email Address: HANDLER ENTER JR. HANDLER # if applicable Exhibitor or owner MUST sign on the signature line beneath the instructions. In Case of Emergency - Name: Phone #: (NOT REQUIRED) AEAGL2 (12/13) OFFICIAL AMERICAN KENNEL CLUB AGILITY ENTRY FORM K-9 Obedience Training Club of Menomonee Falls AGREEMENT Jan 31 & Feb 1, 2015 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. Opens:12/3/2014 ● Draw:1/2/2015 ● Closes:1/16//2015 SATURDAY SUNDAY BOTH DAYS Standard Jumpers T2B Daily Entry Fee: 1st run $22; $16 each additional run Make checks payable to: K-9 OTC Mail to: Lorah Marquardt, Event Secretary, 1124 W River Dr, Stevens Point WI 54481 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 PREFERRED Classes 8” 12” 16” 20” 24” 26” STD Nov A Nov B Open Exc Master 4” 8” 12” 16” 20” STD NovP OpenP ExcP MasterP JWW Nov A Nov B Open Exc Master JWW NovP OpenP ExcP MasterP FAST Nov A Nov B Open Exc Master FAST NovP OpenP ExcP MasterP T2B T2B T2B T2BP Non-Regular Classes International Sweepstakes ISC Jump Height - Select: 14” 18” 26” -or- □ □ □ This Dog Needs To Be Measured BREED □Yes □No □STD □JWW □Jump Height Same as Regular/Preferred SEX HEIGHT AT WITHERS VARIETY CALL NAME PAL NO. □ FOREIGN REG. NO & COUNTRY BREEDER 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. 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) 233-9767. 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? _____________________________________________ Enter Complete Registration # below AKC® NO 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. Dogs listed in the AKC Canine PartnersSM 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. AKC® NAME (INCLUDE AKC TITLES ONLY) □ ILP NO. □ AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club Web site, www.akc.org. DATE OF BIRTH ___________________________________________________________________________________________________ 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. PLACE OF BIRTH (LIST COUNTRY) □ SIRE DAM SIGNATURE of owner or his agent duly authorized to make this entry. ACTUAL OWNERS OWNERS ADDRESS SIGN HERE NEW ADDRESS X ______________________________________________________ Telephone Number: CITY, STATE ZIP + 4 □New Email Email Address: HANDLER ENTER JR. HANDLER # if applicable In Case of Emergency - Name: Exhibitor or owner MUST sign on the signature line beneath the instructions. Phone #: (NOT REQUIRED) AEAGL2 (12/13)
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