GSDCA-WDA
ORANGE COUNTY SCHAEFERHUNDE KLUB
SHOW ENTRY FORM
Orange Country Schaeferhunde Klub
September 27, 28, 29, 2013
Algonquin Park
Powder Mill Road and Rte 52
Newburgh, NY 12550
FINAL ENTRY DEADLINE: September 21, 2013
Event Chair: Fernando Burgos – Kuehnhaus@aol.com
Long Stock Hair (LSH)
☐ Yes ☐ No
Registered Name:
Sex: ☐ Male ☐ Female
Date of Birth (mm/dd/yyyy):
SV or other FCI #:
Tattoo #:
Microchip #:
Working Titles:
Show Rating:
SV Körmeister's Name:
Latest Körung Date (mm/dd/yyyy):
Dog Info
Country:
(Must be FCI recognized kennel club registry)
"a" Hip Certification
☐ N/A
☐ Normal
☐ Fast Normal
☐ Noch Zugelassen
Foreign Certification
☐ Hip
☐ Elbow
Country:
OFA Hips
☐ N/A
☐ Excellent
☐ Good
☐ Fair
"ED" Elbow Certification
☐ N/A
☐ Normal
☐ Fast Normal
☐ Noch Zugelassen
Registered Name of Sire:
Registered Name of Dam:
AKC #:
AKC #:
SV or other FCI # w/ Country:
SV or other FCI # w/ Country:
Working Titles:
Show Rating:
Working Titles:
Show Rating:
Breed Surveyed in Körklasse:
Breeder Info
Country of Birth:
AKC #:
Breed Surveyed in Körklasse:
☐ N/A
☐ Yes ☐ No
Owner Info
Breed: GSD
☐ Yes
☐ No
Breed Surveyed in Körklasse:
Name:
Phone:
E-Mail:
Address:
City:
State:
GSDCA-WDA
☐ Yes ☐ No ☐ Exempt
GSDCA-WDA Member #:
GSDCA Member
☐ Yes ☐ No ☐ Exempt
GSDCA Member #:
Name:
Phone:
E-Mail:
Address:
City:
State:
GSDCA-WDA
☐ Yes ☐ No ☐ Exempt
GSDCA-WDA Member #:
GSDCA Member
☐ Yes ☐ No ☐ Exempt
GSDCA Member #:
GSDCA-WDA Official Show Entry Form
☐ Yes
☐ No
Zip:
Country:
Zip:
Country:
Rev. 02/04/13
Co-Owner Info
Name:
Phone:
E-Mail:
Address:
City:
State:
GSDCA-WDA
☐ Yes ☐ No ☐ Exempt
GSDCA-WDA Member #:
GSDCA Member
☐ Yes ☐ No ☐ Exempt
GSDCA Member #:
Zip:
Country:
☐ Registration/proof of ownership (i.e. AKC registration, Bescheinigung, etc.)
☐ Four (4) generation pedigree from country of birth (if born after 1/1/2005)
☐ Tattoo or Microchip Verification (if not on pedigree, for 12 months and older)
☐ Legally required vaccinations (i.e. rabies, etc.)
☐ SV HD Stamp on original pedigree papers or proof of OFA Hip Certification - Working or Veterans Classes
☐ SV ED Stamp on original pedigree papers if born on or after 1/1/2004 - Working or Veterans Classes
☐ Scorebook (GSDCA/GSDCA-WDA, SV, UScA, GSSCC or other FCI recognized club with proof of at least
SchH1/VPG1/IPO1 or HGH title) – Working or Veterans Classes
☐ Breed Survey, if 3.5 years of age or older, a V-rating requires a valid breed survey – Working Class
Entry Fee
(if received
by 1st deadline)
Entry Fee
(if received
by 2nd deadline)
Baby Puppy Class (3-6 Months)
$40
$xx
Entry Fees
Check
One
Class
☐
☐
☐
☐
☐
Junior Puppy Class (6-9 Months)
$40
$xx
Senior Puppy Class (9-12 Months)
$40
$xx
Youth Class (12-18 Months)
$50
$xx
Young Dog Class (18-24 Months)
$50
$xx
☐
Working Dog Class (24 Months or Older)
(SchH or IPO Title Required)
$55
$xx
☐
**Adult/Open Class (24 Months or Older
w/o SchH or IPO Title)
$55
$xx
☐
**Veterans Class (6 years or Older
w/ SchH or IPO Title)
$55
$xx
☐
☐
**Progeny Group
$xx
$xx
**Kennel Group
$50
$xx
Checks payable to:
OrangeCounty Schaeferhunde
Klub
Payment Info
Required Paperwork
☐ I understand that to complete this entry, I must forward copies of the following documents with my entry form:
Mail entry form,
payment & copies of required
documents to:
Patrick Kuehn
8 Cooksboro Rd
Troy NY 12182
Release
Statements
** May not be offered at some events.
Reference is hereby made to (a) the GSDCA-WDA Event & Services Statement, (b) the Liability Release and (c) the Arbitration Provision
(collectively hereinafter referred to as the "Releases"). By this reference, the Releases are incorporated herein as though set forth in full.
These “Releases” are located at the end of this document and must be read before signing the entry form.
I am the ☐ owner, ☐ handler, or ☐ duly authorized agent of this entry. I have read and understand and agree to the “Releases”.
Signature: _________________________________ Printed Name: ______________________________ Date:
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You must enclose copies of all required documents with this entry.
The original documents must be presented to the Show Secretary at check-in.
Incomplete entries, entries that are not signed, and entries without proper documentation will not be accepted.
Entries that are not received on or before the event deadline date will not be accepted.
All entries are non-refundable.
GSDCA-WDA Official Show Entry Form
Rev. 02/04/13
GSDCA-WDA EVENT & SERVICES PRIVACY STATEMENT: The German Shepherd Dog Club of America - Working Dog Association ("WDA")
is committed to protecting its members' privacy as well as the privacy of those who participate in WDA-sanctioned events and who utilize any
services provided by the WDA.
Anyone who (1) participates in any WDA-sanctioned event (including without limitation any German Shepherd Dog Conformation Show, Breed
Survey or Trial) or (2) uses any services provided by the WDA (including without limitation the certification of a dog's hips or elbows) provides
information to the WDA which may be considered personal. Information that is provided may include, without limitation, (1) any information that
identifies you such as your name, address, email address, telephone number and credit card information, (2) any information that identifies your
German Shepherd Dog such as your dog's name, breed registry registration number, tattoo number and/or microchip number and (3) any
information concerning your German Shepherd Dog's conformation show rating, trial scores, working titles as well as your German Shepherd
Dog's hip and elbow ratings, among other things.
You are hereby put on notice that all of the information herein, except for credit card information, will be compiled into a National Database
("Database") maintained by the WDA. This information is collected for the purpose of servicing and responding to your current needs and to
develop a system that can help facilitate the future processing of services and needs for both you and your German Shepherd Dog.
As a requirement for participating in any WDA-sanctioned events and for enjoying the benefits of the various services offered by the
WDA, you hereby consent to the collection of the following information provided by you for inclusion into the Database: all information
contained in the ownership and registration documents, pedigree certificates, show cards, score books, hip and/or elbow certifications,
breed survey documents, vaccination records and any other documents issued for and submitted in support of your dog's entry into
any WDA-sanctioned event. Notwithstanding, no Credit Card Information will be included in the Database.
The WDA may, from time to time, change the provisions of this privacy policy. Any changes will be posted on the official WDA website
http://www.gsdca-wda.org/ and published in accordance with procedures approved by the WDA Board. You hereby consent to and agree to the
terms and provisions of the privacy policy as may be changed from time to time by the WDA.
The WDA will handle all information that you provide in a confidential manner and will share this information only as necessary to complete (1) the
processing of entries into WDA-sanctioned events, (2) the processing of services requested for your dog or (3) the maintenance of the Database.
Anyone receiving confidential information from the WDA will be required to sign and deliver a Non-Disclosure Agreement to the WDA.
LIABILITY RELEASE: In consideration of the German Shepherd Dog Club of America-Working Dog Association ("WDA") accepting this entry
form for review and consideration, the undersigned(s) agrees to defend and to hold the German Shepherd Dog Club of America ("GSDCA"), the
WDA and the event-giving club, their respective members, directors, officers, governors, agents, superintendents, event chair, event secretary,
the owner/lessor/management of the property on which the event will take place and any provider of services that are necessary to hold this event
and any employees or volunteers of the aforementioned parties, and any judge officiating at this event, harmless from any claim for loss or injury
which may be alleged to have been caused directly or indirectly to any person or thing by the act of any dog(s) that is owned, handled, or under
the control of or while in the care of the undersigned(s) while in or about the event premises or grounds or near any entrance thereto. The
undersigned(s) personally assumes all responsibility and liability for any such claim and agrees to defend and to hold the aforementioned parties
harmless from any claim for loss, injury or damage suffered by any such dog(s).
The undersigned(s) further assumes the sole responsibility for and agrees to indemnify, defend and save the aforementioned parties harmless
from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for
damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person or persons, including the
undersigned(s), or on account of damage to property, arising out of or in consequence of the participation by the undersigned(s) in this event,
regardless of how such injuries, death or property damage may be caused and whether or not the same may have been caused or may be
alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other persons.
ARBITRATION PROVISION: THE UNDERSIGNED(S) AGREES THAT ANY CAUSES OF ACTION, CONTROVERSY
OR CLAIMS ARISING OUT OF OR RELATED TO EITHER (A) ANY OF THE PROVISIONS OR TERMS OF THIS ENTRY
FORM; OR (B) THE EVENT WHICH IS THE SUBJECT OF THIS ENTRY, INCLUDING WITHOUT LIMITATION ANY
ISSUES CONCERNING THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THE PROVISIONS HEREIN
SHALL BE SETTLED BY ARBITRATION IN LOS ANGELES, CALIFORNIA UNDER THE COMMERCIAL
ARBITRATION RULES OF THE AMERICAN ARBITRATION ASSOCIATION, THEN EXISTING. JUDGMENT ON THE
ARBITRATION AWARD MAY BE ENTERED IN ANY COURT HAVING JURISDICTION OVER THE SUBJECT MATTER
OF THE CONTROVERSY. NOTWITHSTANDING, ANY JUDGMENT ENTERED OR ANY ARBITRATION AWARD MAY
BE APPEALED AS IF IT WERE A JUDGMENT OBTAINED AT A CIVIL TRIAL. ALL DISCOVERY AS PROVIDED BY
THE CALIFORNIA CODE OF CIVIL PROCEDURE IN CIVIL ACTIONS SHALL BE AVAILABLE TO THE PARTIES IN
ARBITRATION AS IF THE ARBITRATION WERE A CIVIL TRIAL PROCEEDING. PRIOR TO COMMENCING
ARBITRATION, ALL APPLICABLE WDA BYLAWS, RULES, REGULATIONS, PROCEDURES AND PUBLISHED
POLICIES AND GUIDELINES MUST FIRST BE FOLLOWED.
GSDCA-WDA Official Show Entry Form
Rev. 02/04/13