OFFICIAL UNITED KENNEL CLUB CONFORMATION ENTRY FORM

1 show 1 JS1 show 2 JS2 show 1 JS1 show 2 JS2 show 1 JS1 show 2 JS2 Date Date Date Dog must not be entered without a permanent UKC registration number or a UKC Temporary Listing number. Checkone of the two boxes below and enter your dog s number. If your dog s permanent registration is pending at UKC, andyou do not have a valid TL number, your ENTRY will be s UKC permanent reg. UKC TL UKC (PL/LP) #_____ Breed of dog:_____ Variety (if applicable):_____ Sex:____Dog s Name: _____Call Name: _____Date of Birth:_____Junior Name: _____Junior #: _____Dog owner s name(s):_____Address:_____City:_____Stat e:_____ZIP_____Telephone (day):_____ (eve):_____Email: _____OFFICIAL UNITED KENNEL CLUB CONFORMATION ENTRY FORM Signature of Owner/Handler DateI have read and agree to the waiver on this form.

2 I swear that this dog is not being handled by aprofessional handler in Fee:FO136 FBL/Rev. 10-18 CONFORMATION (Only Choose One) Puppy (6 months-under 1 year) Junior (1 year-under 2 years) Adult (2 years & over) Open (6 months & over) Breeder & Handler (6 months & over shown bybreeder) Champion (CH) Grand Champion (GRCH)Non-Licensed Class: _____Altered CONFORMATION (Only Choose One) Puppy (6 months-under 1 year) Junior (1 year-under 2 years) Adult (2 years & over) Open (6 months & over) Breeder & Handler (6 months & over shown bybreeder) Champion (CH) Grand Champion (GRCH)P l e a s e c h e c k t h e b o x f o r t h e a p p r o p r i a t e c l a s s . IMPORTANT INFORMATION ABOUT THIS ENTRY FORM: 1. All entries must be submitted on the current OFFICIAL UKC ENTRY Form . You may use one ENTRY formto enter the same dog in more than one show on the same weekend.

3 2. Use a separate ENTRY form for each dog entered in a club's Mail all completed ENTRY forms to the Event Secretary listed under the event, unless otherwise specified. Make checks payable to host want you to keep the points earned at UKC Licensed events. Important things to remember: Dog not UKC registered? Apply for a Temporary Listing Number (TL) online at (TL fees are non-refundable, non-transferable and do not apply to the cost of permanent registration.) All dogs entering UKC events must be permanently registered, have a validTemporary Listing Number, or a Performance Listing/Limited Privilege number. All ENTRY forms must be completed and signed. Incorrect information submitted on the ENTRY form mayinvalidate your wins. To be eligible to enter into the Breeder/Handler class, you must be one of the breeders of record, ora member of the immediate family of one of the breeders of record.

4 Immediate family includes:spouse, parent, step-parent, child, step-child, sibling, grandchild, or in-law, so long as the handler isnot a professional handler as defined by UKC Rules and UNITED KENNEL Club complies with the Americans with Disabilities Act. If you require anaccommodation, please contact the Event Chair or Secretary for this club s events are held under the OFFICIAL Rules and Regulations of the UNITED KENNEL Club. Absolutely noalcoholic beverages, illegal drugs or firearms will be allowed on the grounds or in the buildings on theday of a UKC Licensed event. UKC, its agents and employees, and the host club assume no responsi-bility for any loss, damage, or injury sustained by spectators or by exhibitors and handlers, or to any oftheir dogs or property, and further assume no responsibility for injury to children not under the control oftheir parents or guardians. UKC and the host club are not responsible for loss, accidents or theft.

5 By signing this form, I hereby agree to waive any claim, action, or lawsuit and further agree to indem-nify and hold UKC, the host club and any approved UKC Judge harmless from any claims, actions or law-suits resulting from my participation in this event, and any action, decision or judgment made by any UKCor host club representative or approved Judge under the OFFICIAL UKC Rules and Regulations governingthis event. I acknowledge that the current OFFICIAL UKC Rules and Regulations (Agility, CONFORMATION ,DockJumping, Drag Race, Junior Showmanship, Lure Coursing, Obedience, Rally Obedience, Weight Pull)have been made available to me, and that I am familiar with their contents. My signature indicates that Iunderstand and agree to the above and to abide by all of the current OFFICIAL UKC Rules and Regulations. Please print or type all not complete this form until you have read and signed the without CLUB USE ONLYA rmband: _____Dog weight: _____HOSTCLUB_____ If owner is a minor/Signature of Parent or Guardian DateJunior ShowmanshipClasses Pee Wee (2 years-under 4 years) Sub JR (4 years-under 6 years) Pre-Junior (6 years-under 8years) Novice Junior (8years-under 13 years) Open Junior (8years-under 13 years) Novice Senior (13years-18 years) Open Senior (13years-18 years)Total Dog/Total Junior Total Dog Total Junior Participant(if applicable)