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