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Hegins Valley Police and Schutzhund Club
Entry and Waiver Form

**Please Complete the Entire Form**

Circle Title Desired:**SchH 1**SchH 2**SchH 3**BH**OB1**OB2**OB3**TR1**TR2**TR3

Tracking-Only Titles are available only as space permits**

Circle Day Preference:**********Saturday**********

Dog's Name:____________________________________________________Tatoo#:____________________

Titles:_____________________________________________Scorebook #:____________________________

Handler/Owner Trained?(circle)*****YES*****NO**Date/Club BH earned:______________

Date Whelped:____________________Registration#:_____________________________________________

Breed:___________________________Gender: (circle)*****Male*****Female

Owner Name:______________________________________________________________________________

Owner Address:____________________________________________________________________________

Owner Phone:_________________________________Owner Email:__________________________________

Handler Name: (If different than owner)__________________________________________________________

Handler Address:___________________________________________________________________________

Handler Phone:________________________________Handler Email:_________________________________

USA/DVG/AWDF Member #: ___________________ Exp. Date: _________________________

**ALL COMPETITIORS MEET PROMPTLY AT 0630 HRS. AT THE CLUB GROUNDS, WITH SCOREBOOK**

ENTRIES MAILED AFTER AUGUST 19,2005, please add $5 LATE FEE.

FEES: SchH 1, 2, 3..............$50/Companion "BH"...............$45

**WAIVER**

It is understood that every dog on the training grounds will be, at all times, in the care and control of the dog's owner/handler. It is further understood that the undersigned agrees to be fully responsible for the actions of the dog while on the training grounds. I agree to release the Club,its Officers, and Members, and the Property Owners of the training or show grounds from any loss, injury, or accident which may occur to myself or my dog while attending this function.

Signature of Owner/Handler:___________________________________________________________________

Print Name:___________________________________________________________________


We provide this form for your convenience. If you wish to enter our upcoming trial, please print the form, fill it out, and contact us for the address to which you should send your entry and fee.


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