Dog's registered name_______________________________________Titles________________________
Breed:  _______________________________________________  Sex:  ___________________________
Date of Birth:____________________________________  Tattoo #:  ______________________________
Registration #:  _______________________  Registry:  ________________________________________
Scorebook #:  __________________________________  Titles:  _________________________________
Sire:___________________________________________________  Title(s):_______________________
Dam:___________________________________________________ Title(s):_______________________
Breeder:  ______________________________________________________________ 
Owner/Handler:________________________________________________________________________ 
Address:______________________________________________________________________________
City:  _____________________________________________  State:  ______  Zip:  __________________

Club membership: �USA  �DVG  �AWDF  Member Club name___________________________________ 
USA Local Club Affiliations:______________________________________ 
USA Membership #:  _________________________  Email Address: ______________________________
Day Phone:  ______________________________  Evening Phone:  _______________________________

Read the following statements carefully: It is hereby understood that every dog at this trial 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 dogs owned by another but in the undersigned's care and to hold harmless  all members, officers and directors of the host club,, the  United Schutzhund Clubs of America, and any property owners  associated with this event in case of accident or injury.  I hereby assume all responsibilities and liabilities for myself and my dogs and agree to abide by all USA guidelines and rules.