JD13 QUESTIONNAIRE FOR A PROPOSED UK RESIDENT CHAMPIONSHIP SHOW/’GRANDFATHERING’ JUDGE 1 SHOW DETAILS PLEASE COMPLETE IN BLOCK CAPITALS AND INK BREED IIIIIIIII IIIIIIIIIIIIIIIIIIIIIII SHOW (if applicable) I IIIIIIIIIIIIIIIIIIII IIIIIIII DATE OF SHOW (if applicable) D D MM Y Y Y Y SEX TO BE JUDGED (if applicable) DOG BITCH BOTH (Please tick box) 2 NOMINEE’S DETAILS & DECLARATION PLEASE COMPLETE IN BLOCK CAPITALS AND INK TITLE MR MRS MISS MS (Please tick box) OTHER Kennel Club ID No. (If known) SURNAME IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII FIRST NAME(S) Name by which you are known for judging purposes I IIIIIIIIIIIIIIIIIII KENNEL NAME I IIIIIIIIIIIIIIIIIIIIIIIIIIIII ADDRESS I IIIIIIIIIIIIIIIIIIIIIIIIIIIIII III IIIIIIIIIIIIIIIIIIIIIIIIIIIIII POSTCODE IIIIIIIIIIIIIII IIII IIIIIIIIIII TEL NO IIIIIIIIIIIIIIIIMOBILE NO IIIIIIIIIIIIII EMAIL IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII DATE OF BIRTH D D MM Y Y Y Y * DECLARATION I hereby declare that the information given is correct, and if, at any time, altered circumstances render my replies no longer accurate, I undertake to notify the Board of the Kennel Club immediately. I undertake to familiarise myself with the Kennel Club Breed Standard for the breed, Kennel Club Regulations, Kennel Club Code of Best Practice for Judges, and judge according to them. I understand that I may have to consider withdrawing from the appointment in appropriate circumstances or that the nominating society may have to withdraw the appointment in the event of a change in circumstances. *N.B. Personal details marked with * will be kept confidential. If you DO NOT wish your name and contact details to be published either in printed or internet format, please tick this box. A tick will prevent your details being included on the 'Find a Judge' website. SIGNATURE DATE D D MM Y Y Y Y 3 BREED CLUB/COUNCIL OPINION Are you included on any lists of Judges compiled by a Breed Club or Council for THIS Breed? FOR OFFICE USE ONLY If so please state the title of Club and List: NAME OF CLUB LIST DATE OF LIST A3 OPIN NOTES A B C D E F G H I J FOR OFFICIAL USE ONLY DATE OF RECEIPT D D MM Y Y Y Y CLASSES DATE OF CTTEE MEETING D D MM Y Y Y Y DATE PROCESSED D D MM Y Y Y Y DOGS JUDGED DATE OF BIRTH D D MM Y Y Y Y REQ YES NO DEFERRED SIG JDP REQ Decision Notes: CLUB SIG 5 or 7 YEARS JUDGING BREED CLUB SHOW POLICY BREED CLUB SEMINAR JDP CREDIT OTHER CC BREEDS STUD BOOK No.s STEWARDING No.s 1st TIME REQUIREMENTS: RDSJ PASS TRAINER DATE D D MM Y Y Y Y C&M PASS TRAINER DATE D D MM Y Y Y Y HOA PASS TRAINER DATE D D MM Y Y Y Y 4 JUDGING EXPERIENCE OF THIS BREED IN THE UK Please list below the names and dates of shows at which you have judged classes of breed/variety in the UK. If a breed has more than one variety, please list the varieties separately. Documentary evidence of entries may be required and must be provided if requested. Please DO NOT include overseas judging which may be listed under Section 5. You may include future UK appointments which have been confirmed in writing. Please read notes before completing figures. NOTE 1: This is to indicate ONLY those classes in which dogs were actually present, not simply those scheduled. NOTE 2: The Committee wants to know the actual number of dogs entered, i.e. excluding second and subsequent entries for each dog. If in doubt please contact the nominating society for guidance. NOTE 3: This requirement must be included for all shows held after 1st January 1995 and should exclude absentees. NAME OF SOCIETY IF SUPPORTED ENTRY DATE OF SHOW TYPE OF NO. OF CLASSES NO. OF DOGS ACTUAL NO. OF HOLDING SHOW NAME OF BREED SHOW JUDGED ENTERED DOGS PRESENT CLUB OR COUNCIL AND JUDGED (SEE NOTE 1) (SEE NOTE 2) (SEE NOTE 3) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Please continue on a separate spreadsheet in the same format (if required). TOTALS 5 OVERSEAS JUDGING EXPERIENCE IN THIS BREED NAME OF SOCIETY DATE OF COUNTRY NO. OF DOGS ACTUALLY HOLDING SHOW SHOW PRESENT AND JUDGED 1 2 3 4 5 6 7 8 6 OTHER UK JUDGING EXPERIENCE Do you award CCs in other breeds? YES NO If yes, give date of first judging appointment at CC level for ANY breed: Non-specialist judges are advised to summarise their experience by grouping the numbers of dogs they have judged by breed and group. NAME OF SOCIETY DATE OF TYPE OF BREED/VARIETY NO. OF NO. OF DOGS HOLDING SHOW SHOW SHOW (LIST EACH VARIETY SEPARATELY) CLASSES ACTUALLY JUDGED PRESENT 1 2 3 4 5 6 NOTE: The Committee does not require a full C.V. of all breeds judged – entries on some or all of the above 6 lines will be sufficient. 7 SEMINARS AND MANDATORY REQUIREMENTS A. If you have not awarded Challenge Certificates for the first time in any breed you must have completed a number of mandatory requirements. If you have not completed any of these requirements you will be asked to do so before being considered to award Challenge Certificates.. If you have previously awarded a Challenge Certificate in any breed go to section 7B. Have you attended a seminar run by a Kennel Club Accredited Trainer (Show) and passed the Kennel Club examination “Requirements of a Dog Show Judge” ? (Sometimes known as the “Rules & Regulations” Seminar). If YES, please indicate name of Trainer and date of examination. Enclose copy of Certificate. YES NO Name of Trainer: Date of Examination: D D MM Y Y Y Y Have you attended a seminar run by a Kennel Club Accredited Trainer (Show) on “Conformation and Movement” ? If YES, please state name of Trainer and date of seminar. Enclose copy of Certificate . YES NO Name of Trainer: Date: D D MM Y Y Y Y Have you passed a “Points of the Dog Assessment” conducted by a Kennel Club Accredited Trainer (Show)? If YES, please state name of Trainer and date of seminar. Enclose copy of Certificate. YES NO Name of Trainer: Date: D D MM Y Y Y Y B. Have you attended a Seminar run by a Group Judges Development Programme (JDP) for THIS BREED? YES NO If YES, did you gain a Pass with Credit RELEVANT TO THIS BREED? If YES, please also indicate date. YES NO Date D D MM Y Y Y Y C. For a nomination to award CC’s for your 1st, 2nd and 3rd breeds you are required to attend and pass a breed specific hands on assessment organised by a Breed Club or Council. A copy of the relevant pass certificate must be enclosed with the relevant questionnaire . Attended Seminar YES NO Passed YES NO Attended Assessment YES NO Name of Club/Council: Date of attendance: D D MM Y Y Y Y D. For Gundog Breed Judges Only. (For Judges being considered to award Challenge Certificates in a Gundog Breed for the first time). Effective 1.1.2011 Have you attended any Field Trial (FT) or an Open Gundog Working Test (GWT) for the relevant Sub Group for THIS BREED? YES NO If YES, please indicate name of club and enclose copy of signed card . Any FT Open GWT Date : D D MM Y Y Y Y If THIS breed is in a different sub-group to a previously approved CC breed, it is preferable but not compulsory that a FT or GWT is attended. 8 DOGS OWNED OR BRED BY NOMINEE A. Please list below the names and numbers of dogs of THIS breed in the Stud Book which are, or have been, a. bred by you, or b. owned by you at the time they were first entered in the Stud Book. Kennel Club policy requires a first-time Challenge Certificate Judge to have three dogs entered in the Stud Book. If you do not meet this criterion please provide an explanation in the Notes Section below. For 'Grandfathering' in non-CC breeds please list dogs owned/bred by you with significant wins (include full details). NAME OF DOG KCSB NO. 1 2 3 4 5 6 Notes B. Please state the approximate number of dogs of THIS breed that have been registered in your name at the Kennel Club, including puppies NUMBER OF DOGS: 9 OTHER INFORMATION A. If you are have not awarded Challenge Certificates in any breed, please list below the number of occasions when you have stewarded at Open or Championship Shows. Please state name of club and dates. Summarise if necessary. Kennel Club policy requires a first-time judge to have stewarded over a minimum of 12 days at shows. 17 28 39 4 10 5 11 6 12 B. Do you receive sponsorship or payment of any kind, for example, for handling at shows or preparing dogs for exhibition? YES NO If Yes, please provide details below. C. Do you have any disability which would impair your judging THIS breed? If YES, please give brief details. YES NO D. Please provide any other information in the space provided about your involvement with this breed which may be helpful to the Committee in considering this application. 10 DECLARATION BY NOMINATING SOCIETY (IF APPLICABLE) PLEASE COMPLETE IN BLOCK CAPITALS AND INK The Committee of the having considered the information given in this questionnaire, forward this nomination for the consideration of the Kennel Club, and is doing so more than 12 months prior to the date of the show.