OFFICIAL ENTRY FORM
(Tracking Test)

OFFICIAL ENTRY FORM
(Tracking Test)

	

COMPETITIVE SERVICE DOG CLUB OF ALBERTA                                                        COMPETITIVE SERVICE DOG CLUB OF ALBERTA
                                               MAY 27, 2017   (A.M.)                                                                                                          MAY 27, 2017   (P.M.)

Name of Club:	 			Name of Club:	 	

   EVENT  INFORMATION 

FEES:      Entry Fee      $		Listing Fee    $		Total Enclosed     $	

   EVENT  INFORMATION 

FEES:      Entry Fee      $		Listing Fee    $		Total Enclosed     $	

TEST ENTERED:

DATE:     	

TEST ENTERED:

DATE:     	

TD TDX
UTD UTDX

TD TDX
UTD UTDX

DOG INFORMATION

DOG INFORMATION

Registered Name of Dog:	Call Name: 		Registered Name of Dog:	Call Name:   	

Insert Number Here:       	

Breed: 			Variety 		Male	Female CKC Registration #	CKC Miscellaneous #
CKC ERN #	Listed
CKC PEN #

Breed: 			Variety 		Male	Female CKC Registration #	CKC Miscellaneous #

Insert Number Here:       	

CKC ERN #	Listed
CKC PEN #

dd	mm	yy
Date of Birth: 		Place of Birth:	Canada	Elsewhere

dd	mm	yy
Date of Birth: 		Place of Birth:	Canada	Elsewhere

Breeder: 		Breeder:      	

Sire:	 		Sire:	 	

Dam:	 		Dam:	 	

OWNER(S)  &  AGENT INFORMATION

OWNER(S)  &  AGENT INFORMATION

Registered Owner(s): 		Membership No. 		Registered Owner(s): 		Membership No.   	

Membership No.   		 	

Membership No.   		 	

Membership No.   	
Membership No.   	

Handler:	 		Handler:	 	

Street Address	City	Prov.	Postal Code

I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the actual owner(s) whose name(s) I have entered above and accept full responsibility for all statements made in this entry. In consideration of the acceptance of this entry, I (we) agree to be bound by the rules and regulations of The Canadian Kennel Club and by any additional rules and regulations appearing in the premium list.

(	)

Owner’s  Address: Name of Agent (if any) : Agent’s Address:

Street Address	City	Prov.	Postal Code

I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the actual owner(s) whose name(s) I have entered above and accept full responsibility for all statements made in this entry. In consideration of the acceptance of this entry, I (we) agree to be bound by the rules and regulations of The Canadian Kennel Club and by any additional rules and regulations appearing in the premium list.

(	)

Owner’s  Address: Name of Agent (if any) : Agent’s Address:

I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the actual owner(s) whose name(s) I have entered above and accept full responsibility for all statements made in this entry. In consideration of the acceptance of this entry, I (we) agree to be bound by the rules and regulations of The Canadian Kennel Club and by any additional rules and regulations appearing in the premium list.

(	)

Signature of Owner or Agent

Telephone Number

Email

I CERTIFY that I am the registered owner(s) of the dog or that I am the authorized agent of the actual owner(s) whose name(s) I have entered above and accept full responsibility for all statements made in this entry. In consideration of the acceptance of this entry, I (we) agree to be bound by the rules and regulations of The Canadian Kennel Club and by any additional rules and regulations appearing in the premium list.

(	)

Signature of Owner or Agent

Telephone Number

Email