| Name _______________________________________________________ Address _____________________________________________________ City ___________________________ State _________ Zip __________ Phone # ______________________ E-mail Address _______________________________________________ Law Enforcement Agency and/or Schutzhund Organization affiliation: ____________________________________________________________ ____________________________________________________________ |
| SEMINAR REGISTRATION |
| If you bring a dog: Dog's name _________________________ Breed __________________ Registry ______________________ Titles _________________________ Sire __________________________ Dam _________________________ Veterinarian _________________________ Phone # _________________ Last checkup date ____________________ OFA Cert ________________ Innoculation due dates: Rabies ____________ DHLPPC ____________ Parvo _______________ Corona ____________ Bordatella ____________ |
| ___ ___ ___ ___ ___ ___ |
| PLEASE READ CAREFULLY: In consideration of the acceptance of this application, I hereby agree to waive any and all claims against the St. Louis Schutzhund Association, Inc., it's officers, trainers, members, members' dogs and property owners for possible loss or damage which may occur to any person, animal or thing as a result of being a spectator or taking part in association activities. Furthermore, it is understood by every owner/handler that every dog will be at all times in the care and control of that dog's owner/handler, and that the owner/handler who is the undersigned agrees to be fully responsible for the actions of this/her dogs. And I realize that by signing, I might be relinquishing or waiving certain legal rights I otherwise would have had. Signed ______________________________________________ Date _________________________ |
| Contact person: John Roeslein at 314-378-8567 or jrracejr@cs.com |
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