ONLINE Entry Form

k9Crazy Play Skool

April 17th 2010, Stone Ridge, NY

Entries close Sunday, March 21st , 2009 at 10 p.m.

Owner/Handler Information

Name:

Address:

City:

State:

Zip:

Phone:

Alt: Phone:

Email:

Dog Information

Reg. Name:

APDT Reg#: NOTE: You MUST have an APDT Registration #, entries will not be accepted if left blank!

Call Name: Height at Withers: Jump Height

Date of Birth: Breed:

Check Titles Held: Level1 Level 2 Level 3

Handler's Name: (MUST be member of immediate family)

Entries accepted on a first-come-first served basis. Confirmations will be sent out after entries have closed.

Trial Entry and Fee Information

	Saturday April 17th
Puppy AM	A Tara Baggerman B
Level 1 AM	A Tara Baggerman B
Level 2 AM	A Diane Cordero B
Level 3 AM	A Kim Wilson B
Veteran AM	A Kim Wilson B

Puppy PM	A Tara Baggerman B
Level 1 PM	A Tara Baggerman B
Level 2 PM	A Diane Cordero B
Level 3 PM	A Kim Wilson B
Veteran PM	A Kim Wilson B

Will you be filing an exercise modification for this dog/handler? Yes No

Mail Check (Number of Rounds Selected x $24) PayPal (Number of Rounds Selected x $26)

Entry Fee Total

VERY IMPORTANT

We NEED Volunteers to help things run smoothly!

Sign me up as a trial volunteer!! Lunch provided for volunteers.

I have special diet needs, explain

Please let us know if you may be earning a NEW title at our trial.

We may earn our ...

RL1

RL2

RL3

RL1X

RL2X

RL3X

ARCH

ARCHX

ARCHEX

Veteran Dog - 8 yrs or older

Therapy Dog - Registered

Mixed Breed/Rescue/Shelter Dog

Junior Handler - 16 yrs or younger

Handicapped Dog

Senior Handler - 65 yrs or older

I, Full Name , have READ and ACCEPT

the terms of the General Agreement .

A confirmation form will show on your screen after you hit submit.

Please PRINT form and mail with check to

k9Crazy Rally O, 15 Goat Hill Rd, Saugerties, NY 12477

Confirmations will be sent 1 week prior to show date. If we fill prior to receiving your entry we will contact you immediately.