GERMAN SHEPHERD DOG CLUB OF AMERICAWORKING DOG ASSOCIATION, INC.
OFFICIAL TRIAL ENTRY FORM
Central Virginia Schutzhund Club
Dude Ranch Pet Resort
11015 Dude Ranch Road
Glen Allen, VA 230
Nov 22nd and 23rd 2014
Wendell Nope, SV
Jacob B. Pope,Jr. Chairperson
http://cvschutzhundclub.com/club-training-schedule.html
Breed:
Sex: ☐ Male ☐ Female
Reg. # if foreign born:
Date of Birth (Year Month/Day):
AKC Reg. #:
(Must be FCI recognized kennel club registry)
Tattoo #:
or
Working Titles:
HOT:
Handler
Info
Owner Info
Country:
☐ Yes ☐ No
BHOT: ☐ Yes ☐ No
WUSV or FCI Organization: ☐ GSDCA-WDA or ☐ Other:
Scorebook #:
Name:
Telephone:
Address:
E-Mail:
City:
☐ GSDCA-WDA or ☐ Other:
Membership #:
State:
Zip:
Exp. Date:
☐ Check if owner is same as Handler
Name:
Telephone:
Address:
E-Mail:
City:
State:
Zip:
Co-owner Name (if applicable):
Check
One
☐
IPO1
Entry Fees
Country of Birth:
Microchip #:
Title
$65
Late
Entry Fee
$65
Entry Fee
☐
IPO2
$65
$65
☐
IPO3
$65
$65
☐
IPO-A 1-3:
$55
$55
☐
BH
$55
$55
☐
FH1 - FH2:
$65
$65
☐
FPr/TR 1-3:
$55
$55
☐
UPr/OB 1-3:
$xx
$xx
☐
SPr/Defense 1-3:
$xx
$xx
☐
AD
$xx
$xx
☐
IPO FH
$65
$65
☐
Other: Specify Title
$xx
$xx
Make Checks payable to:
Replace with Club Name
Mail entry form and payment to:
Jacob B. Pope, Jr.
4456 Riverdale Ave, Glen Allen, VA 23060
Payment Info
Dog Info
Registered Name:
If you do not have a GSDCA/GSDCA-WDA scorebook and you have a
registered GSD, you must submit an FCI or WUSV recognized scorebook
along with copies of:
1. Dog’s registration (or other proof of ownership)
2. Pedigree: American born dogs must have a 4 generation AKC
pedigree that is tattoo or microchip certified; foreign born dogs must present
a pedigree from their country of birth.
3. If the pedigree is not tattoo/microchip certified, you must present an
original veterinarian tattoo/microchip verification (form on website).
All other breeds/mixed/unregistered GSD’s must have a verifiable tattoo or
microchip at check in.
I am the ☐ owner, ☐ handler, or ☐ duly authorized agent of this entry. I have read and understand and agree to the RELEASE STATEMENT and WAIVER OF LIABILITY that follow.
Signature: _______________________________
GSDCA-WDA Official Entry Form
Printed Name: _________________________________ Date: ____________
Page 1 of 2
Rev. 07/15/13
* Originals of all documents must be presented to the Trial Secretary at check-in.
* SV scorebooks MUST be certified by the GSDCA-WDA office prior to entry.
* All dogs must have a scorebook.
* All dogs must be healthy and current on all legally required vaccinations.
* 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.
GSDCA-WDA Official Entry Form
Page 2 of 2
Rev. 07/15/13
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 GSDCA-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.
Release Statement
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 Entry Form
Page 3 of 2
Rev. 07/15/13