Dec 7-8, Winter Trial Entry Form
USCA Judge: Vadim Plotsker
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Please complete all boxes on the entry form exactly how you want it to appear in the paperwork.
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Once your form has been received, the trial secretary will email you instructions on how to make payment for your entry.
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ENTRIES ARE NOT CONSIDERED COMPLETE UNTIL PAYMENT IN FULL HAS BEEN RECEIVED.
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You will receive a second email confirming that your entry is completed with payment.
YOU MUST BRING YOUR USCA MEMBERSHIP CARD AND DOG'S SCOREBOOK WITH YOU TO THE TRIAL -
NO EXCEPTIONS.
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** There is an additional $50 fee for Non-USCA members.
A microchip reader will be provided by ICWDC.
Dog's registered name
Sex:
HOT
DOB
Breed
Scorebook#
Registration
Tattoo/Chip#
Titles
Date and organization where BH obtained
Sire
Dam
Handler's Full Name
USCA# or None
Expiration
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Non - USCA
Address
City
State
Zip
Phone
Owner's Full Name (if different from handler)
Owner's Address
Owner's City
Owner's State
Owner's Zip
Title Entered For
**There is an additional $50 fee for non-USCA Members
Payment Preference
INFORMED CONSENT AND RELEASE
It is hereby understood that every dog at this event will be under the direct care and control of its handler. The undersigned agrees to be fully responsible for any and all actions of their dog, including owned by another but in the undersigned’s care, and to hold harmless all members, officers and directors of Inner City Working Dog Club and any property owners associated with this event in case of accident, injury or death, either to oneself or one’s dog and loss of property. Any and all protests must be submitted in writing to the Trial Secretary only.
SUBMBISSION OF THIS FORM SERVES AS CONSENT TO THE ABOVE STATEMENT AND ACTS AS DIGITAL SIGNATURE.
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