I Am the Owner, Handler, Or Duly Authorized Agent of This Entry. I Have Read and Understand

Wesley Chapel Dog Training Club 4101 Hay Rd., Lutz FL 33559 January 19-21 Ann Beattie, Trial Chair/Secretary SV judge Helmut Konig Helper Timo Rieg 4101 Hay Rd., Lutz FL 33559

Registered Name: Breed: D Date of Birth (Year Month/Day): Sex: ☐Male☐ Female Country of Birth: o Reg. # if foreign born: g AKC Reg. #: Country: In Tattoo #: or Microchip #: f o Working Titles: HOT: ☐ Yes ☐ No BHOT: ☐ Yes ☐ No Scorebook #: WUSV or FCI Organization: ☐GSDCA or☐ Other:

H Name: Telephone: E-Mail: a Address: City: State: Zip: n dl er Membership #: ☐GSDCA or☐ Other: Exp. Date: In fo

O ☐ Check if owner is same as Handler w n Name: Telephone: E-Mail: er Address: City: State: Zip: In fo Co-owner Name (if applicable):

Chec Make Checks payable to: Entry k Title WCTDTC Fee One Mail entry form and payment to: ☐ IPO1 ($20 to helper) $125 Wesley Chapel Dog Training Club ☐ IPO2 ($20 to helper) $125 P 4101 Hay Rd., Lutz FL 33559 a E ☐ IPO3 ($20 to helper) $125 y If you do not have a GSDCA scorebook and you have a n registered GSD, you must submit an FCI or WUSV ☐ AD $60 m tr recognized scorebook along with copies of: ☐ BH $60 e y n 1. The dog’s registration (or other proof of ownership); F ☐ Breed Survey $150 2. Pedigree. American born dogs must have a 4 t e ☐ 3-6 Male /female $50 generation AKC pedigree that is tattoo or microchip I certified; foreign born dogs must present a pedigree from e ☐ 6-9 male/female $50 n the dog’s country of birth. s ☐ 9-12 male/female $50 3. If the pedigree is not tattoo or microchip certified, you f must present an original veterinarian tattoo/microchip 12-18 male female o $65 verification (form on website). ☐ 18-24 mo male/female ☐ Untitled male/female $65 All other breeds and mixed or unregistered GSD’s must have a verifiable Working Class $65 tattoo or microchip at check in. ☐ male/female

I am the ☐ owner,☐ handler, or ☐ duly authorized agent of this entry. I have read and understand and agree to the RELEASE STATEMENT and WAIVER OF LIABILITY that follow.

ENTRIES CLOSE JANUARY 8,2018 * Originals of all documents must be presented to the Trial Secretary at check-in. * SV scorebooks MUST be certified by the GSDCA office prior to entry. * All dogs must have a scorebook. * All dogs must be healthy and current on all legally required vaccinations. * Incomplete entries, entries that are not signed, and entries without proper documentation will not be accepted. PAYMENT MUST ACCOMPANY ALL ENTRIES * Entries that are not received on or before the event deadline date will not be accepted. Participation in any GSDCA sanctioned event

Anyone who (1) participates in any GSDCA sanctioned event (including without limitation any German Shepherd Dog Conformation Show, Breed Survey or Trial) or (2) uses any services provided by the GSDCA (including without limitation the certification of a dog's hips or elbows) provides information to GSDCA which may be considered personal. Information that is provided may include, without limitation, (1) any information that identifies you such as your name, address, email address, telephone number and credit card information, (2) any information that identifies your German Shepherd Dog such as your dog's name, breed registry registration number, tattoo number and/or microchip number and (3) any information concerning your German Shepherd Dog's conformation show rating, trial scores, working titles as well as your German Shepherd Dog's hip and elbow ratings, among other things.

You are hereby put on notice thatall of the information herein, except for credit card information, will be compiled into a National Database ("Database") maintained by the GSDCA. This information is collected for the purpose of servicing and responding to your current needs and to develop a system that can help facilitate the future processing of services and needs for both you and your German Shepherd Dog.

As a requirement for participating in any GSDCA sanctioned events and for enjoying the benefits of the various services offered by the GSDCA, you hereby consent to the collection of the following information provided by you for inclusion into the Database: all information contained in the ownership and registration documents, pedigree certificates, show cards, score books, hip and/or elbow certifications, breed survey documents, vaccination records and any other documents issued for and submitted in support of your dog's entry into any GSDCA sanctioned event. Notwithstanding, no Credit Card Information will be included in the Database.

GSDCA may, from time to time, change the provisions of this privacy policy. Any changes will be posted on the official WDA website Releas e http://www.gsdcaorg and published in accordance with procedures approved by the GSDCA Board. You hereby consent to and agree to the State terms and provisions of the privacy policy as may be changed from time to time by the GSDCA. ment GSDCA will handle all information that you provide in a confidential manner and will share this information only as necessary to complete (1) the processing of entries into GSDCA sanctioned events, (2) the processing of services requested for your dog or (3) the maintenance of the Database. Anyone receiving confidential information from GSDCA will be required to sign and deliver a Non-Disclosure Agreement to GSDCA.

LIABILITY RELEASE: In consideration of the German Shepherd Dog Club of America("GSDCA") accepting this entry form for review and consideration, the undersigned(s) agrees to defend and to hold the German Shepherd Dog Club of America ("GSDCA", and the event-giving club, their respective members, directors, officers, governors, agents, superintendents, event chair, event secretary, the owner/lessor/management of the property on which the event will take place and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, and any judge officiating at this event, 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 any dog(s) that is owned, handled, or under the control of or while in the care of the undersigned(s) while in or about the event premises or grounds or near any entrance thereto. The undersigned(s) personally assumes all responsibility and liability for any such claim and agrees to defend and to hold the aforementioned parties harmless from any claim for loss, injury or damage suffered by any such dog(s).

The undersigned(s) further assumes the sole responsibility for and agrees to indemnify, defend 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 therefrom, sustained by any person or persons, including the undersigned(s), or on account of damage to property, arising out of or in consequence of the participation by the undersigned(s) in this event, regardless of how such injuries, death or property damage may be caused and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other persons.

6/20/17