BARN HUNT ENTRY FORM (FPOS)

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Family Pet Obedience School, LLC
4890 Hammond Industrial Drive, Suite 100
Cumming, GA 30041
OPEN TO ALL BREEDS AND MIXED BREEDS OF ALL SIZES
Six Trials offered- earn a title in one weekend

Permission has been granted by
the Barn Hunt Association, LLC
for the holding of these barn hunt
trials under BHA Rules and
Regulations.

Barn Hunt FUN TEST - February 13 *

Fun Test on Friday February 13 Beginning at 5 pm

I am NOT entering this event

Instinct - $5 per dog

Novice, Open, Senior, Master $10 per dog

Required

FEBRUARY BARN HUNT TRIAL 1 February 14, 2015

Saturday Trial 1 is FULL - NO Day of Trial or Online Entries will be accepted

BARN HUNT TRIAL 2 February 14, 2015 *

aturday Trial 2 is FULL - NO Day of Trial or Online Entries will be accepted

FEBRUARY BARN HUNT TRIAL 3 February 15, 2015 *

Choose which trial and level you are entering

I AM NOT ENTERING THIS TRIAL

02-15 INSTINCT $15 (BEFORE 02-06)

02-15 NOVICE $20 (BEFORE 02-06)

02-15 OPEN $20 (BEFORE 02-06)

02-15 SENIOR $20 (BEFORE 02-06)

02-15 MASTER $20 (BEFORE 02-06)

Required

BARN HUNT TRIAL 4 February 15, 2015 *

Choose which trial and level you are entering

I AM NOT ENTERING THIS TRIAL

02-15 NOVICE $20 (BEFORE 02-06)

02-15 OPEN $20 (BEFORE 02-06)

02-15 SENIOR $20 (BEFORE 02-06)

02-15 MASTER $20 (BEFORE 02-06)

Required

FEBRUARY BARN HUNT TRIAL 5 February 16, 2015 *

Choose which trial and level you are entering

I AM NOT ENTERING THIS TRIAL

02-16 INSTINCT $15 (BEFORE 02-06)

02-16 NOVICE $20 (BEFORE 02-06)

02-16 OPEN $20 (BEFORE 02-06)

02-16 SENIOR $20 (BEFORE 02-06)

02-16 MASTER $20 (BEFORE 02-06)

Required

BARN HUNT TRIAL 6 February 16, 2015 *

Choose which trial and level you are entering

I AM NOT ENTERING THIS TRIAL

02-16 NOVICE $20 (BEFORE 02-06)

02-16 OPEN $20 (BEFORE 02-06)

02-16 SENIOR $20 (BEFORE 02-06)

02-16 MASTER $20 (BEFORE 02-06)

Required

Entry Amount Total *

Total Entry Fees from above - Remember if you are paying with Credit Card $1.00 will be added to each class to cover charges

PAYMENT - If paying with a Credit Card $1 will be added to EACH entry to cover fees

Choose your method of payment below. If you are paying by check you must pront this form and mail with your check before the closing date. If you are paying with a credit card - please enter the information below. A receipt will be emailed to you

I am paying by check

I am paying by credit card

I have "bucks" I am applying to my entry. (Remember to either mail in the "bucks" with your entry and check, or bring them and turn them in at the trial if you are paying with credit card. Remember to deduct from your total!

Voucher

Volunteer Bucks Amount

Remember to deduct this amount from your total

Check Number and Amount

Credit Card Number

Expiration Date

Security Code (on the back)

Billing Zip Code

Amount Authorized to be Charged - Don't forget to add $1.00 to each class you are entering to cover CC charges

Full Name of Dog *

Call Name of Dog *

Breed of Dog *

Sex of Dog *

Bitches in Season MUST be declared (they can compete in panties at the end)

Male

Female

Neutered Male

Spayed Female

Bitch in Season

Date of Birth or "Gotcha Day" *

Dogs MUST be at least 6 months of age to compete

Height Class *

Small 13" and under

Medium 13.1 to 18"

Large 18" and over

Actual Owner(s) *

Street Address *

City *

State *

Zip Code *

Actual Height of Dog (at the shoulder) *

Barn Hunt Registration # *

All dogs are REQUIRED to have a Barn Hunt Registration number prior to entering. Register your dog online at www.barnhunt.com

CERTIFICATION OF AGREEMENT UPON ENTRY OF DOG *

I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of the Barn Hunt Association, LLC in effect at the time of this event, and by any additional rules and regulations appearing in the premium list for this event, and further agree to be bound by the liability waiver enclosed with my entry. I (we) certify and represent that the dog entered is not a hazard (dog or human aggressive) to persons or other dogs. This entry is submitted for acceptance on the foregoing representation and Agreement. I (we) agree to conduct myself (ourselves) in accordance with all Barn Hunt Association, LLC Rules and Regulations and to abide by any decisions made in accord with them

I have read and agree with the above Agreement

I have read and do NOT agree with the above Agreement. I understand that by NOT agreeing , my dog may not be entered in this Trial

Signature of owner or agent duly authorized to make this entry *

Type your legal name or paste a digital signature below

Date *

Date you are making this entry

Parent or Guardian Signature if participant is under 18 years of age:

Telephone # *

Email Address *

ENTRIES WILL BE CONFIRMED BY EMAIL PRINT YOUR EMAIL CLEARLY. IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL, PLEASE EMAIL: familypet@mindspring.com

LIABILITY WAIVER - Your entry must be complete with BHA number and signed with liability waiver initialed. *

I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to win prizes, ribbons, and/or trophies, I (we) agree to hold Barn Hunt Association, LLC, the event giving club, their directors, governors, officers, agents or event secretary and the owner and/or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties, and any BHA LLC approved judge, judging 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 this dog while in or about the event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree 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 there from, sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries, death or property damage may be caused, and whether or not the same may be caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any persons.

By Initialing below, I indicate my agreement with the above Liability Waiver.

I do NOT agree with the above LIABILITY WAIVER and understand that I will not be allowed to compete or be on the premises

Initial here to indicate you AGREE with the LIABILITY WAIVER *

MEDIA RELEASE FORM *

I hereby authorize club-appointed videographer and/or photographer to use, reproduce, and/or publish photographs and/or video that may pertain to me, including my image, likeness and/or voice without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, the BHA LLC website, yahoo group or face book page, or for other related endeavors. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, the BHA, LLC or show-giving club may publish materials, use my name, photograph, and/or make reference to me in any manner that the Corporation or project sponsor deems appropriate in order to promote/publicize service opportunities.

By Initialing below, I indicate my agreement with the above Media Waiver.

I do NOT agree with the above MEDIA WAIVER and understand that I will not be allowed to compete or be on the premises

Initial here to indicate you AGREE with the MEDIA WAIVER *

Security

YOUR INFORMATION IS SECURE AND IS NEVER SHARED WITH A THIRD PARTY

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