Entry Form

AHA CHUTE OUT ENTRY FORM

* Indicates required field

Breed *

Variety *

Sex *

Date of Birth Month *

Date of Birth DAY *

DATE of BIRTH YEAR *

Registered Name of Dog *

Registration Number *

Select One *

Call Name *

Breeder *

Sire *

Select One Sheep AM DAY ONE *

Select One DUCKS DAY ONE *

Select One Sheep PM DAY ONE *

Dam *

Select One SHEEP AM DAY TWO *

Select One Ducks DAY TWO *

Select One SHEEP PM DAY TWO *

Actual Owner(s) *

Select One HT/PT Trial #1 *

Select One HT/PT Trail #2 *

Address *

Handler Name First *

Handler Name Last *

Phone Number *

I I CERTIFY that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry I (we) agree to abide by the rules and regulations of the American Kennel Club in effect at the time of this Herding Test or Trial and by any additional rules and regulations appearing in the premium list for this Herding Test or Trial or both, and further agree to be bound by 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 acceptance on the foregoing representation and agreement. I (we) agree to conduct myself(ourselves) in accordance with all such Rules and Regulations (including all provisions applying to discipline) and to abide by any decisions made in accord with them.

Typing Name in lue of Signature *

Email *

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