GSDCA-WDA SEMINAR ENTRY FORM

CAROLINA FOOTHILLS SCHUTZHUND VEREIN SEMINAR WITH HELMUT HUBER February 27 – March 1, 2015 12551 Franklin Road, Thonotosassa, Florida

Registered Name: Breed: o

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

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

l Name: Phone: E-Mail: d n

a Address: City: State: Zip: Country: H o f Member #: GSDCA-WDA 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 I understand that to enter as active participant, I must provide copies of the following documents with my entry form: u q

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

Check Event Entry Fee One Checks payable to: Active Participant 3 days $350.00 Tom Kimball o f s n e I

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

n required documents to: y e r

t Tom Kimball m n Audit Participant 3 days $150.00 y 6337 Summerfield Loop E a

P New Port Richey, Fl 34655 e s a

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

t incorporated herein as 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.

Signature: ______Printed Name: ______Date: ______

GSDCA-WDA EVENT & SERVICES PRIVACY STATEMENT: The German Shepherd Dog Club of America - Working Dog Association ("WDA") is committed to protecting its members' privacy as well as the privacy of those who

GSDCA-WDA Official Trial Entry Form Rev. 10/15/14 participate in WDA-sanctioned events and who utilize any services provided by the WDA.

Anyone who (1) participates in any WDA-sanctioned event (including without limitation any German Shepherd Dog Conformation Show, Breed Survey or Trial) or (2) uses any services provided by the WDA (including without limitation the certification of a dog's hips or elbows) provides information to the WDA 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 that all of the information herein, except for credit card information, will be compiled into a National Database ("Database") maintained by the WDA. 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 WDA-sanctioned events and for enjoying the benefits of the various services offered by the WDA, 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 WDA-sanctioned event. Notwithstanding, no Credit Card Information will be included in the Database.

The WDA may, from time to time, change the provisions of this privacy policy. Any changes will be posted on the official WDA website http://www.gsdca-wda.org/ and published in accordance with procedures approved by the WDA Board. You hereby consent to and agree to the terms and provisions of the privacy policy as may be changed from time to time by the WDA.

The WDA 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 WDA-sanctioned events, (2) the processing of services requested for your dog or (3) the maintenance of the Database. Anyone receiving confidential information from the WDA will be required to sign and deliver a Non-Disclosure Agreement to the WDA.

LIABILITY RELEASE: In consideration of the German Shepherd Dog Club of America-Working Dog Association ("WDA") 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"), the WDA 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.

ARBITRATION PROVISION: THE UNDERSIGNED(S) AGREES THAT ANY CAUSES OF ACTION, CONTROVERSY OR CLAIMS ARISING OUT OF OR RELATED TO EITHER (A) ANY OF THE PROVISIONS OR TERMS OF THIS ENTRY FORM; OR (B) THE EVENT WHICH IS THE SUBJECT OF THIS ENTRY, INCLUDING WITHOUT LIMITATION ANY ISSUES CONCERNING THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THE PROVISIONS HEREIN SHALL BE SETTLED BY ARBITRATION IN LOS ANGELES, CALIFORNIA UNDER THE COMMERCIAL ARBITRATION RULES OF THE AMERICAN ARBITRATION ASSOCIATION, THEN EXISTING. JUDGMENT ON THE ARBITRATION AWARD MAY BE ENTERED IN ANY COURT HAVING JURISDICTION OVER THE SUBJECT MATTER OF THE CONTROVERSY.

GSDCA-WDA Official Trial Entry Form Rev. 10/15/14 NOTWITHSTANDING, ANY JUDGMENT ENTERED OR ANY ARBITRATION AWARD MAY BE APPEALED AS IF IT WERE A JUDGMENT OBTAINED AT A CIVIL TRIAL. ALL DISCOVERY AS PROVIDED BY THE CALIFORNIA CODE OF CIVIL PROCEDURE IN CIVIL ACTIONS SHALL BE AVAILABLE TO THE PARTIES IN ARBITRATION AS IF THE ARBITRATION WERE A CIVIL TRIAL PROCEEDING. PRIOR TO COMMENCING ARBITRATION, ALL APPLICABLE WDA BYLAWS, RULES, REGULATIONS, PROCEDURES AND PUBLISHED POLICIES AND GUIDELINES MUST FIRST BE FOLLOWED.

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