OFFICIAL UNITED KENNEL CLUB PERFORMANCE …

1 Dog must not be entered without a permanent UKC registration number, a UKC Temporary Listing number or a UKC PerformanceListing/Limited Privilege number. Check one of the three boxes below and enter your dog s number. If your dog s permanent registration ispending at UKC, and you do not have a valid TL number, your entry will be s UKC permanent reg. UKC TL UKC (PL/LP) #_____Breed:_____ Variety (if applicable):_____ Sex:_____Dog s Name:_____Call Name:_____ Date of Birth:_____Junior s Name: _____Junior #:_____Dog owner s name(s):_____Address:_____City:_____ State/Prov.

2 :_____ Postal Code_____Telephone (day):_____ (eve):_____Email:_____OFFICIAL UNITED KENNEL club PERFORMANCE ENTRY FORMI have read and agree to the waiver on this form. Entry Fee:FO135 FBL/Rev. 9-17 Agility Classes AGI A AGI B AGII A AGII B AGIIID ivision Toy (10" & under) 1 (over 10"-14") 2 (over 14"-20") 3 (over 20")Junior/Veteran Junior Handler Veteran Dog (7 years & over)Lure Coursing Classes Coursing Aptitude Test (CA) Coursing Test (CT) Regular Stake (Please attach proof of eligibility) INFORMATION ABOUT THIS ENTRY FORM: 1. All entries must be submitted on the current OFFICIAL UNITED KENNEL ClubPerformance Entry Form.

3 You may use one entry form to enter the same dog inmore than one activity on the same weekend. 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, unlessotherwise specified. Make checks payable to host All UKC PERFORMANCE events are open to any UKC registered dogs and dogs with avalid PERFORMANCE Listing/Limited Privilege number, with the exception of LureCoursing and Drag Racing. Please see the rules for each event regarding eligability. 5. We want you to keep the points earned at UKC Licensed events.

4 Important things to remember: Dog not UKC registered? Apply for a Temporary Listing Number (TL) online (TL fees are non-refundable, non-transferableand do not apply to the cost of permanent registration.) All dogs entering UKC events must be permanently registered, have avalid Temporary Listing Number, or a PERFORMANCE Listing/ LimitedPrivilege number. All entry forms must be completed and signed. Incorrect information submittedon the entry form may invalidate your wins. All events are held under the OFFICIAL Rules and Regulations of the UNITED KENNEL no alcoholic beverages, illegal drugs or firearms will be allowed on the grounds orin the buildings on the day of a UKC Licensed event.

5 UKC, its agents and employees, and thehost club assume no responsibility for any loss, damage, or injury sustained by spectators orby exhibitors and handlers, or to any of their dogs or property, and further assume no respon-sibility for injury to children not under the control of their parents or guardians. UKC and the hostclub are not responsible for loss, accidents or theft. By signing this form, I hereby agree to waive any claim, action, or lawsuit and further agreeto indemnify and hold UKC, the host club and any approved UKC Judge harmless from anyclaims, actions or lawsuits resulting from my participation in this event, and any action, decisionor judgment made by any UKC or host club representative or approved Judge under the offi-cial UKC Rules and Regulations governing this event.

6 I acknowledge that the current OfficialUKC Rules and Regulations (Agility, Conformation, Dock Jumping, Drag Race, Juniors, LureCoursing, Obedience, Rally Obedience, Weight Pull) have been made available to me, and thatI am familiar with their contents. My signature indicates that I understand and agree to theabove 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 waiver. Invalid without club USE ONLYA rmband: _____Dog weight: _____HOSTCLUB_____Obedience Classes Novice A Novice B Novice C Open A Open B Utility A Utility BDog s Height at Withers_____ Standard Jump Height Minimum Jump HeightJunior/NLC Junior Handler Non Licensed ClassPlease List_____Dock Jumping (Check Splashes) 1 2 3 4 5 6 7 8 9 10 Please list any additional splashes.

7 _____Drag RaceFlat Aptitude Regular Champion Grand ChampionSteeplechase Aptitude Regular Champion Grand ChampionDog s Height at Withers_____Weight Pull A B Junior HandlerRally Obedience Classes RO 1 A RO 1 B RO 2 A RO 2 B RO 3 A RO 3 BJump Height(6", 10", 14")_____Junior/Veteran Junior Handler Veteran Dog (7 years & over)Total Dog/Junior Total Dog Participant Total Junior ParticipantSignature of Owner/Handler DateIf owner is a minor/Signature of Parent or Guardian Date(if applicable) Trial/Meet/Pull 1 Trial/Meet/2 Trial/Meet/Pull 1 Trial/Meet/2 Trial/Meet/Pull 1 Trial/Meet/2 Trial/Meet/Pull 1 Trial/Meet/2 DateDateDateDat