ONLINE Entry Form

k9Crazy Play Skool

October 22nd 2005, Stone Ridge, NY

Entries close Monday, September 26th , 2005 at 10 p.m.

Owner/Handler Information

Name:

Address:

City:

State:

Zip:

Phone:

Alt: Phone:

Email:

Dog Information

Reg. Name: APDT Reg#: Pending:

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 August 6th
Level 1 AM	A Deb Kreider B
Level 2 AM	A Linda Sperco B
Level 3 AM	A Linda Sperco B

Level 1 PM	A Deb Kreider B
Level 2 PM	A Kim Wilson B
Level 3 PM	A Linda Sperco B

Using Food: Yes No

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

Mail Check (Number of Rounds Selected x $22) PayPal (Number of Rounds Selected x $24)

Entry Fee Total

Sign me up as a trial volunteer!!

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 Dog

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 after close of trial.