South Metro-Atlanta Schutzhund Club

GSDCA SEMINAR ENTRY FORM

CAROLINA FOOTHILLS SCHUTZHUND VEREIN SEMINAR WITH HELMUT HUBER February 5, 6, 7 2016 12551 Franklin Road, Thonotosassa, Florida www.carolinafoothillsSV.com

Registered Name: Breed:

o Date of Birth (mm/dd/yyyy): Country of Birth: f Sex: Male Female n I

o Working Titles: D WUSV or FCI Organization GSDCA Other: r e

l Name: Phone: E-Mail: d n

a Address: City: State: Zip: Country: H o f Member #: GSDCA or Other: n I o f

n Name: Phone: E-Mail: I

r o t i

d Address: City: State: Zip: Country: u A d e r i

u I understand that to enter as active participant, I must provide copies of the following documents with my entry form: q e R k

r Legally required vaccinations (i.e. rabies, etc.) o w r e p a P

Check Event Entry Fee One Checks payable to: Active Participant 3 days $390.00 Sigrid Riess-Mundry o f s n e I

e Mail entry form, payment, and copies of t F

n required documents to: y e r

t Janis Skeath m

n th Audit Participant 3 days $190.00 y 12351 NE 55 Place E a

P Williston, FL 32696 Phone: 352 486-2641 Email: [email protected] e s a

e Reference is hereby made to (a) the GSDCA Event & Services Statement, (b) the Liability Release and (c) the Arbitration l e Provision (collectively hereinafter referred to as the "Releases"). By this reference, the Releases are incorporated herein as R s

t though set forth in full. n e

m These “Releases” are located at the end of this document and must be read before signing the entry form. e t a t S I am the owner, handler, or duly authorized agent of this entry. I have read and understand and agree to the foregoing RELEASE STATEMENT and WAIVER OF LIABILITY.

GSDCA-WDA Official Trial Entry Form Rev. 10/15/14 Signature: ______Printed Name: ______Date: ______

Liability Release The German Shepherd Dog Club of America, Inc. (GSDCA) is not responsible for any injuries or damage suffered by persons or animals participating in this event during, before, or after the actual event. By acting as spectator and/or participating in any capacity, I waive any right or action against the GSDCA and will hold the GSDCA harmless if any action, or lack of action by my dog(s) or by me results in any action against the GSDCA. I am the (check one) owner ___, handler ___, duly authorized agent to make this entry. I have read, and understand, and agree to the Liability

GSDCA-WDA Official Trial Entry Form Rev. 10/15/14