Herding Trial Entry Form

Select the event:

BREED:

VARIETY:

GENDER:

Male Female

DOB:

(format 2014-01-24)

TITLES BEFORE:

(AKC titles only for AKC trials)

NAME OF DOG:

(Call name for unregistered dogs)

TITLES AFTER:

(AKC titles only for AKC trials)

REGISTRATION NUMBER:

CALL NAME:

REGISTRATION ORGANIZATION:

PLACE OF BIRTH (USA, Canada, etc):

BREEDER:

SIRE:

DAM:

HANDLER(S):

ADDRESS:

CITY:

ST: ZIP:

TELEPHONE:

EMAIL:

ACTUAL OWNER(S):

Same as Handler

ADDRESS:

CITY:

ST: ZIP:

TELEPHONE:

EMAIL:

LEVEL:

Select an Event Above

Total Entry Fees:

COB Total:

Only applies when paying via PayPal

Late Fees:

Only applies when paying AFTER the closing date

Club Member Discount (AHBA ONLY):

Please enter discount amount, eligibility and discount amount will be verified

Total:

NOTE: If the total is incorrect, you will be able to alter it on the next page after submitting your entry

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 national organization in effect at the time of the Herding Test/Trial and by any additional rules and regulations appearing in the premium list for this Herding Test/Trial or both. 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. In addition, I have read and agree to the AGREEMENT at the bottom of this entry form
SIGNATURE of owner or agent duly authorized to make this entry.

Signature: ______________________________________________ For mailed applications only

Contact information of Owner and/or agent:
(online application will not be accepted if missing this information)
Print Name:
Email:
Phone #:

Date:

Electronic Signature: By typing your name above (under print name) and checking this box you are stating you are the person above, and that you have read and agree to all 8 statements on this application, and that all information supplied is accurate to the best of your knowledge: (THIS BOX MUST BE CHECKED FOR YOUR APPLICATION TO BE ACCEPTED!)

Payment Options and other Instructions

Please select your payment method below. (Note: your entry is not complete until your fees have been paid in full, credit card payments can be made via PayPal)

If mailing your payment in, please note the date you submitted your application, the name on the application (if not the same as on the check or money order). MAKE CHECKS OUT TO SPVHC. NOTE: COB fee does not apply to mailed payments Click "Submit" for futher details.

Use the Note field below to enter any special information, such as if payment will be from an account (PayPal or checking) not tied to your name, any special processing needs, etc.
Notes:

You may want to save a copy of this form for your records before you hit submit.

Entry Fee Payment: To pay via Paypal, hit the Submit button then use the "shopping cart" on the next page.
To pay with check or money order, please use the directions above. After printing your entry form, please hit the submit button on this page to be automatically added to the trial database.

AGREEMENT

I (we) acknowledge that the "Rules Applying to Registration and Dog Shows" and the "Rules for Herding Tests and Trials" have been made available to me (us) and that I (we) agree that the club holding this Herding Test or Trial has the right to refuse this entry for cause which the club shall deem to be sufficient. In consideration of the acceptance of this entry and of the holding of the Herding Test or Trial and of the opportunity to have the dog tested or judged and to win prize money, ribbons, or trophies, I (we) agree to hold this club, its' members, directors, governors, officers, agents, superintendents or show secretary and owner or lessor of the premises and any employees of the aforementioned parties 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 upon the Herding Test or Trial premises or grounds or near any entrance thereto, and I(we) personally assume all responsibility and liability for any such claim for damage or injury to the dog, whether such loss, disappearance, theft, damage or injury be caused or alleged to be caused by the negligence of the club or any of the parties aforementioned, or by the negligence of any other person, or any other causes.
I (we) hereby assume the sole responsibility for and agree to indemnify 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 the Herding Test or Trial, howsoever such injuries, death or damage to property 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.
I (we) will pay for any livestock injuries or replacement value in the event of death of any livestock by my (our) dog. In case of any injury to any stock caused by the dog entered, I (we) will assume total responsibility for any damage
I (we) agree to pay the full market value of the injured animal in case of serious injury, or the veterinarian bill if the injury is slight.
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 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.

Single copies of the latest editions of the "Rules Applying to Registration and Dog Shows", the "Obedience Regulations" and the "Regulations for Herding Tests and Trials" may be obtained WITHOUT CHARGE from the AMERICAN KENNEL CLUB, 5580 Centerview, Raleigh, NC 27606

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