Please be sure that your dog is current with all inoculations including rabies and that proof is available upon
check in. Please notify us if your bitch is in season at time of trial.
BBCR #: _________________________ Breed: _________________________________
Dog's Registered Name: ___________________________________________________________
Date Of Birth: __________/ __________/ __________ Sex: Male Female
Owners Name: ___________________________________________________________________
Address: ________________________________________________________________________
City: ____________________________ State: _______________ Zip: _____________
Phone: __________________________ Email: _____________________________________
Entering for: IDH1___, IDH2___, IDH3___, OBT1___, OBT2___, OBT3___, AT___, IBDT____
25.00 for your first tile- 10.00 per additional title with the same dog.
Total included____________________
Make Checks Payable to: KWDC
RELEASE OF LIABILITY AND AGREEMENT TO HOLD HARMLESS
I, the undersigned, warrant that I understand that attendance at or participation in any dog sport event is not without risk to myself, members of my
family or guests. I also understand that my dog may be subject to risk as a result of the event or exposure to other dogs even under circumstances
where all care is exhibited to prevent any risk. I hereby waive and release the Kansas Working Dog Club, Von Hartwin Kennels, both organizations
officers, members and volunteers and any owners of property where these events may be held from any and all liability of any nature for injury or
damage to my person or my property including my dog and I expressly assume the risk of such injury or damage while attending these events. I
hereby certify that I am the actual owner or the dog entered, or that I am the duly authorized agent of the actual owner whose’ name is listed
above. I further certify that entrance of this dog in this event is specifically within the preview of my agency agreement with the actual owner. I
also certify that the dog entered in this event is the same dog represented by documents presented on entry forms.
Signature: _________________________________________________________Date:________________
check in. Please notify us if your bitch is in season at time of trial.
BBCR #: _________________________ Breed: _________________________________
Dog's Registered Name: ___________________________________________________________
Date Of Birth: __________/ __________/ __________ Sex: Male Female
Owners Name: ___________________________________________________________________
Address: ________________________________________________________________________
City: ____________________________ State: _______________ Zip: _____________
Phone: __________________________ Email: _____________________________________
Entering for: IDH1___, IDH2___, IDH3___, OBT1___, OBT2___, OBT3___, AT___, IBDT____
25.00 for your first tile- 10.00 per additional title with the same dog.
Total included____________________
Make Checks Payable to: KWDC
RELEASE OF LIABILITY AND AGREEMENT TO HOLD HARMLESS
I, the undersigned, warrant that I understand that attendance at or participation in any dog sport event is not without risk to myself, members of my
family or guests. I also understand that my dog may be subject to risk as a result of the event or exposure to other dogs even under circumstances
where all care is exhibited to prevent any risk. I hereby waive and release the Kansas Working Dog Club, Von Hartwin Kennels, both organizations
officers, members and volunteers and any owners of property where these events may be held from any and all liability of any nature for injury or
damage to my person or my property including my dog and I expressly assume the risk of such injury or damage while attending these events. I
hereby certify that I am the actual owner or the dog entered, or that I am the duly authorized agent of the actual owner whose’ name is listed
above. I further certify that entrance of this dog in this event is specifically within the preview of my agency agreement with the actual owner. I
also certify that the dog entered in this event is the same dog represented by documents presented on entry forms.
Signature: _________________________________________________________Date:________________
| Kansas Working Dog Club Spring Fling June 2nd 2012 12:00pm |
| Bull Breed Coalition Registry “Where The Best Of The Best Come To Represent” |
Dog may not be entered in a trial that is hosted as a BBCR trial without a permanent BBCR
registration/contender number. 10.00 contender registration available on site day of show!
Check this box if you plan to register the day of the show.
registration/contender number. 10.00 contender registration available on site day of show!
Check this box if you plan to register the day of the show.