2015 SOUTHWESTERN REGIONAL IPO CHAMPIONSHIP MARCH 27, 28, 29, 2015 Trial Location Ramona, CA, 92065 For additional information contact: Trial Secretary-- Jessica Vampola 760-419-0602, [email protected] Trial Chairman – John Boyer 760-788-2559, [email protected] Schedule: Tracking, Obedience, Protection TBA at the draw Friday Tracking will be on plowed dirt location TBA Entry Form Entries must be postmarked no later than March 16, 2015. Entry form /release must be complete or it will be returned. Make checks payable to: Aztec Schutzhund Club Mail entries to: John Boyer PO Box 2572, Ramona, CA 92065 Titles Offered: IPO1-3, Entry Fees ($125~ IPO) Entry form and waiver must be complete, legible and with payment included for entry acceptance Dog Information – All dogs must be identified by microchip or tattoo with at least 4 legible characters Registered Name of Dog: Call Name: Current Title(s): Registration # Registration Organization: Breed: Sex: Date of Birth: USA Scorebook # HOT (Circle) Yes No Breed Survey Date: Location: Must be completely filled out with owner info Tattoo # Microchip # Entry Information Entry (s) Please check 1 IPO 2 3 Entry Fees Enclosed $ 125.00 Check # Handler Information - Handlers must enclose proof of membership, USCA, FCI, WUSV or AWDF club Name of Handler: Handler e-Mail: Phone: Address: City: Membership # Organization: Date BH Acquired by Handler: Place BH Acquired: State: Zip Expiration Date: Owner Information (if different than handler) Name of Owner: Phone: Address: City: USA Membership # Expiration Date: State Zip Additional Information       Please include a copy of your membership card with entry and bring your membership card to the trial. Judges may now ask to see membership cards. Don’t forget your scorebooks. Only 1 scorebook per dog. No bonds for non-USCA members. Judges may require proof of your dog’s vaccinations. It’s a good idea to bring at least a copy of a current rabies certificate to the trial. ASC will provide beverages and snack items throughout the day including lunch for a nominal fee. We may or may not break for lunch. Please park in designated areas and pick up after your dogs. Do not allow dogs to urinate on buildings, fencing, decks or vegetation around the buildings. Bring shade for your vehicle/dog(s) in case of warm weather. WAIVER AND INDEMNITY AGREEMENT (Must accompany payment and entry form) It is understood that every dog at this event will at all times be in the care and control of the dog’s handler. It is further understood that the undersigned agrees to be fully responsible for the action of his/her dogs while on the trial grounds. I the undersigned as owner or agent agree to hold the United Schutzhund Clubs of America, Aztec Schutzhund Club, ASC its employees, officers, directors, members, guests, judges and property owners and other agents HARMLESS for loss or injury which may have allegedly been caused directly or indirectly to any person or things by any action of my dog(s) or to my dog(s) while on the show/trial premises and surrounding area. I hereby assume all responsibility and liability for such claims. I further agree to indemnify and hold harmless the United Schutzhund Clubs of America, ASC, its employees, officers, directors, members, guests and property owners and other agents free of any and all claims or clams by myself, my family members or any other person accompanying me while on the grounds used for ASC activities or the surrounding areas thereto as a result of any action by any dog, person or activity including those of myself, my family members or guests. Owner or Agent/Handler Signature ______________________________________ Date __________