GSDCA-WDA Trial Entry From

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

H Name: Telephone: E-Mail: a Address: City: State: Zip: n dl er Membership #: ☐ GSDCA-WDA 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 Late Make Checks payable to: Entry k Title Entry Replace with Club Name Fee One Fee Mail entry form and payment to: ☐ IPO1 $xx $xx P Replace with Name For Mailing ☐ IPO2 $xx $xx a Replace with Address For Mailing E ☐ IPO3 $xx $xx y n If you do not have a GSDCA/GSDCA-WDA scorebook and m you have a registered GSD, you must submit an FCI or tr ☐ IPO-A 1-3: $xx $xx e WUSV recognized scorebook along with copies of: y ☐ BH $xx $xx n 1. Dog’s registration (or other proof of ownership) F ☐ FH1 - FH2: $xx $xx t 2. Pedigree: American born dogs must have a 4 e generation AKC pedigree that is tattoo or microchip ☐ FPr/TR 1-3: $xx $xx I e certified; foreign born dogs must present a pedigree from n s ☐ UPr/OB 1-3: $xx $xx their country of birth. f 3. If the pedigree is not tattoo/microchip certified, you ☐ SPr/Defense 1-3: $xx $xx o must present an original veterinarian tattoo/microchip ☐ AD $xx $xx verification (form on website). ☐ IPO FH $xx $xx All other breeds/mixed/unregistered GSD’s must have a ☐ Other: Specify Title $xx $xx verifiable tattoo or microchip at check in.

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.

GSDCA-WDA Official Entry Form Page 1 of 2 Rev. 07/15/13 * Originals of all documents must be presented to the Trial Secretary at check-in. * SV scorebooks MUST be certified by the GSDCA-WDA 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. * Entries that are not received on or before the event deadline date will not be accepted.

GSDCA-WDA Official Entry Form Page 2 of 2 Rev. 07/15/13 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 participate in WDA-sanctioned events and who utilize any services provided by the WDA.

Anyone who (1) participates in any GSDCA-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) Releasthe processing of entries into WDA-sanctioned events, (2) the processing of services requested for your dog or (3) the maintenance of the e Database. Anyone receiving confidential information from the WDA will be required to sign and deliver a Non-Disclosure Agreement to the WDA. State ment 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. 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 Entry Form Page 3 of 2 Rev. 07/15/13