Northeast Ohio Working Dog Association

Official Entry Form

Handler:

 

 

 

 

 

 

 

 

Owner:

 

 

 

 

 

 

 

 

Dog's Registered Name:

 

 

 

 

 

 

Dog's Call Name:

 

 

 

 

 

 

 

Date of birth:

 

 

Breed:

 

Male or Female:

 

Tattoo or Microchip #:

 

Registration #:

 

 

 

Scorebook #:

 

 

USA membership #:

Exp.

 

Club and date first BH was attained:

 

 

 

 

 

Current titles:

 

 

Handler Owned Trained:

 

 

Address:

 

 

 

 

 

 

 

City:

 

 

State:

 

Zip Code:

 

 

Email Address:

 

 

 

Phone #:

 

 

 

 

Please circle

 

 

 

 

 

SchH1 $50

SchH2 $50

SchH3 $50

BH $40

 

 

Ob1 $35

 

Ob2 $35

 

Ob3 $35

 

 

 

Tr1 $35

 

Tr2 $35

 

Tr3 $35

 

 

FH1 $50

 

FH2 $50

 

 

 

 

 
                         

**please note**   BH entries must be 15 months or older, new handler must pass written exam.

    No dog will be allowed to enter without USA scorebook or without SV/other scorebook                                                                          

    stamped by the USA office. 

     Dogs must have a tattoo or microchip in place.  Handlers must provide microchip reader.

It is understood that this event will be conducted in accordance with the current rules and regulations as administered by the USA.  By signing this entry, I agree to abide by these rules, regulations, and decisions.  It is further understood that the Trial Chairperson/Secretary/Judge has the right to dismiss any dog or handler for violation of the rules, or unsportsmanlike conduct.  Entry fees will not be refunded.  I am fully aware of the risks associated with an event of this type, including the risk of accidental injury from a dog.  I am voluntarily assuming those risks, and agree to hold Northeast Ohio Working Dog Assoc., its officers, members, directors, employees, and agents harmless from any claim for injuries I may sustain as a participant or guest at this event.

I represent that I am over 18 years of age and otherwise mentally, and legally competent to execute this form.

Signature:______________________________Date:____________