ONLINE Entry Form

k9Crazy Play Skool

May 28, 29, 30 2005, New Paltz, NY

Entries close Monday, May 2, 2004 at 4 p.m.

Dog Information

Reg. Name: APDT Reg#: Pending:

Call Name: Height at Withers: Jump Height

Using Food: Yes No Check Titles Held: Level1 Level 2 Level 3

Date of Birth: Breed:

Owner/Handler Information

Name:

Address:

City:

State:

Zip:

Phone:

Alt: Phone:

Email:

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

Entry Fee Total

Mail Check (Number of Rounds Selected x $22)

PayPal (Number of Rounds Selected x $24)

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

Senior Handler - 65 yrs or older

Mixed Breed Dog

Junior Handler - 16 yrs or younger

Rescue/Shelter Dog

Therapy Dog - Registered

Handicapped Dog

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.