OFFICIAL ENTRY FORM FOR HUNTING PERFORMANCE TEST Agreement

Basset Hound Club of America Sponsored by Patroon BHC I (we) acknowledge that the “Basset Hound Club of America Hunting Perform- Southern Jersey Beagle Club, 304 Burrs Mill Road, Southampton, NJ ance Test Rules” have been made available to me (us) and that I am (we are) fa- Friday April 30, 2021 miliar with their contents. I (we) waive any and all claims, causes of action, I or ENTRY FEES: $15.00 per hound per test we may otherwise have against the BHCA and all BHCA approved judge(s) Mailed entries close Wednesday, April 28, 2021, 8 p.m. EST or when a total of entries for 15 judging at these tests. I (we) agree that the club holding this test has the right to stakes and 3 alternatives have been received. MAIL ENTRIES WITH FEES MADE PAY- refuse this entry for cause, which the clubs shall deem to be sufficient. In consid- ABLE TO Melissa Phelps, and mailed to Test Secretary, Bill Forrest, 10 Pine St., Peterbor- eration of the acceptance of this entry and of the holding of this test and of the ough, NH 03458 opportunity to have the dog judged and to win ribbons, or trophies, I (we) agree ______to hold this club, its members, directors, governors, officers, agents, superinten- (IMPORTANT: CAREFULLY READ INSTRUCTIONS BEFORE FILLING OUT) dents or show secretary and the owner or lesser of the premises and any employ- BREED VARIETY ees of the aforementioned parties harmless from any claim for loss or injury

REGISTERED NAME AND AKC NUMBER which may be alleged to have been caused directly or indirectly to any persons or thing by the act of this dog while in or upon the hunt test premises or grounds or ______SEX CALL NAME OF DOG near any entrance thereto, and I (we) further agree to hold the aforementioned ______parties harmless from any claim for loss of this dog by disappearance, theft, STAKE (CHECK ONE) SOLO BRACE 2-COUPLED PACK death or damage or injury be caused or alleged to be caused by the negligence of HOUND (CHECK ONE) #1 #2 #1 #2 #3 #4 the club or any of the parties aforementioned, or by the negligence of any other ______person, or any other cause or causes. CHECK “Q” OR “NQ” Q NQ CHECK TITLE FOR THIS ENTRY AND THIS TEST HH SHH MHH I (we) hereby assume the sole responsibility for and agree to indemnify, defend ______and save the aforementioned parties harmless from any and all loss and expenses (Enter number below) DATE OF BIRTH AKC® REGISTRATION NUMBER (including legal fees) by reason of the liability imposed by law upon any of the AKC LITTER NUMBER aforementioned parties for damage because of bodily injuries, including death at PAL/ILP NO. PLACE OF BIRTH (LIST COUNTRY) any time resulting therefrom, sustained by any person including myself FOREIGN REG. NO. (ourselves) or on account of damage to property arising out of or in consequence ______BREEDER of my (our) participation in this hunting performance test, howsoever such inju- ______ries, death or damage to property may be caused and whether or not the same SIRE may have been caused or may have been alleged to have been caused by negli- ______DAM gence of the aforementioned parties or any of their employees or agents or any ______other persons. ACTUAL OWNERS ______Instructions OWNERS ADDRESS NEW ADDRESS ______CITY, STATE, ZIP + 4 A dog must be entered in the name of the person who actually owned it at the ______time entries for a trial closed. If a registered dog has been acquired by a new HANDLER IF JUNIOR HANDLER, PLEASE ENTER # BELOW FEE ENCLOSED $ ______owner, it must be entered in the name of its new owner in any show for which

I CERTIFY THAT I AM THE ATUAL OWNER OF THE DOG OR THAT I AM THE DULY AUTHORIZED AGENT OF THE entries closed after the date of acquirement, regardless of whether the new owner ACTUAL OWNER WHOSE NAME I HAVE ENTERED ABOVE. IN CONSIDERATION OF THE ACCEPTANCE OF THIS has received the registration certificate indicating that the dog is recorded in his ENTRY, I (WE) AGREE TO ABIDE BY THE RULES AND REGULATIONS OF THE BASSET HOUND CLUB OF AMERICA name. State on entry form whether transfer application has been mailed to the IN EFFECT AT THE TIME OF THIS HUNTING PERFORMANCE TEST, AND BY ANY ADDITIONAL RULES AND REGU- LATIONS APPEARING IN THE PREMIUM. JUST FOR THIS HUNTING TEST, AND FURTHER AGREE TO BE BOUND BY AKC (for complete rule, refer to Chapter 11, Section 3.) THE AGREEMENT PRINTED ON THE REVERSE SIDE OF THIS ENTRY FORM. I (WE) CERTIFY AND REPRESENT THAT THE DOG ENTERED IS NOT A HAZARD TO PERSONS OR OTHER DOGS. THIS ENTRY IS SUBMITTED FOR ACCEP- TANCE ON THE FOREGOING REPRESENTATION AND AGREEMENT. PARENT OR GUARDIAN SIGNA- TURE IF OWNER IS UNDER 18. SIGNATURE OF OWNER OR HIS AGENT DULY AUTHORIZED TO MAKE THIS ENTRY. Must be signed here ______

Telephone # ( ) ______

Email: ______