Alaska Working Retriever Club

AKC Reg. No.
OR
AKC Litter No. (If Dog Not Reg.)
OR
ILP No.
OR
Foreign Reg. Number
AND
Country of Registry

Date of Birth

Sire

Dam

Name of Breeder

Actual Owner(s)

Owner's Address

City State Zip

Name of Owner's Agent/Handler

FOR RETRIEVER TRIALS ONLY this dog is qualified for:
limited all-age stake
restricted all-age stake
special all-age stake

AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club website: www.akc.org

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 have the dog judged and to win prizes, ribbons, or trophies, I (we) agree to hold the AKC, the event-giving club, their members, directors, governors, officers, agents, superintendents 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 AKC 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 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 therefrom, 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 have been caused or may be alleged have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other persons. I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES.

SIGNATURE of Owner or Agent Duly Authorized to make this Entry

By checking this box, you agree to the preceding statement. This is equivalent to your written signature.

E-Mail Address

Phone No.

When you click on the Submit button, you will be taken to a payment screen. You will then have the ability to pay your entry fees with PayPal.

If you are not interested in paying your entry fees online or do not wish to create a PayPal account, print this completed form and send a check, payable to AWRC, to:
PO Box 211122
Anchorage, AK 99521

Checks for event registrations must be received by the closing date or the entry will be voided.