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Northern Virginia VPG Club Fall Trial


October 23, 24 and 25 of 2015



 

Blank Form

Northern Virginia VPG Club

USCA - Trial Entry Form

 

 

Trial Entry       [ ] BH   $75          [ ] STP 1   $50         [ ] STP 2   $50       [ ] STP 3   $50

         

          [ ] TR 1   $50        [ ] TR 2   $50     [ ] TR 3   $50     [ ] OB 1   $50      [ ] OB 2   $50   [ ] OB 3   $50

 

                       [ ] IPO 1   $85           [ ] IPO 2   $85       [ ] IPO 3   $85     [ ] FH 1   $85           [ ] FH 2   $85

 

    

Registered Name of Dog  ____________________________________________________________

 

Date of Birth  __________________ 


[  ] Male  [ ] Female   Breed   ______________________________________________ 

 

Scorebook #   ______________________    Dogs Registration #     ______________________ 

 

Tattoo/ Microchip#  ________________________________________________________________ 

 

Owner’s Name ___________________________________________________________________  

 

Owner’s Address _________________________________________________________________ 

 

City  ____________________  State _________________   Zip _____________

 

Owner’s Phone __________________    Other Phone _____________________

 

USCA Member Number __________________________


Club Name ____________________________________________

 

Handler Name:
 
_____________________________________________________________________________________  

 

Handler Address: 

 

City  __________________________________ State _________   Zip _____________

 

Handler Phone ________________________    Other Phone _________________________

 

Handler E-Mail  ________________________________________

 

Date and Organization where Handler achieved BH:
 

__________________________________________________________

USCA Member Number __________________________

Club Name ____________________________________________

 

Please make checks or money orders payable to:  Podium Club. 

Payment MUST accompany entries. 

 

Send Entries to:

Mrs. Sabine Ernsting

137 Egypt Rd.

Kearneysville, WV 25430

 

Release Statement

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 for the actions of that dog, while on the show grounds.  I agree to hold the Northern Virginia VPG Club, the American Kennel Club, and the United Schutzhund Clubs of America, as well as their members, officers, directors, and all property owners harmless for loss or injury which may have 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.

 

Owner or Agent __________________________________________  Date_______________________

 

 

 

 

 

 

 

 

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