High Plains Entry Form

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 of the actions of his/her dog(s) while at this

event. I agree to hold the High Plains SchH Club, Inc., as well as their members

and officers and all property owners HARMLESS for loss or injury, which

may have allegedly 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. I further relinquish all claims

and agree to hold High Plains SchH Club, Inc., their members, officers, and all

property owners HARMLESS for loss and injury, which may have allegedly been

caused directly or indirectly to myself or my dogs(s) during participation in

this event. I also understand that trial titles, times and dates can be changed

up until trial time.

Signature of Owner/Handler: ________________________________ Date:___________

Please circle entry or entries:

SchH/IPO/ 1, 2, 3 = $100 OB/TR = $50

AWD 1, 2, 3 = $75 BH = $50 AD = $50 FH = $100

Conformation Rating: $25 Breed Survey: $110

 

Dog's Registered Name: __________________________________

Titles: _______________________Registration #: _____________

Breed: _______________________ Birthdate: _________ M/F ___

Tattoo#: __________________ Scorebook #: ______________

Handler:_______________________USA Member#____________

Address: ______________________________________________

City/State/Zip: ________________________Phone: ____________

Owner:________________________USA Member#____________

Address: _____________________________________________

City/State/Zip: ________________________Phone: ____________

HOT: yes no    BHOT: yes no        (owner/handler/trained and bred)

Make Checks payable to: "High Plains Schutzhund Club"

Send entry at least a week before trial to:

Ann Marie Chaffin

34187 Cimarron Trail

Elizabeth, CO 80107