Please do not fill this in.

CONTESTANT #

Please read the attached, sign and form return with the $15 entry fee

Registration Form:

Owner’s name_______________________________ Date ___________________

Address________________________________ Phone___________________________

_________________________________

Dog’s name _____________________ Breed __________________________

Age ___________________________ Gender: Male / Female

Can you prove your dog is up to date on all vaccinations? Yes / No

Veterinarian _____________________________________________

Has your dog ever bit anyone? Yes /No

Has your dog ever bit any other dog? Yes/No

Does your dog have any health concerns that may prevent him/her to enter the contest? Yes/No

I understand that I am participating in a contest in which I am responsible for my own dog’s behavior and health. I will not hold any individual volunteer or organization responsible for injury to my dog or myself. I understand that the volunteer has the right to dismiss my dog and myself for any aggression or misbehavior. I also understand the fee is non-refundable. I have read the rule and regulations attached and understand them fully.

If you are under 18 Please have apparent or guardian sign. _____________________________

Print Name

_____________________________

Signature

PLEASE PICK UP YOU AND YOUR DOG’S TRASH AND WASTE. Please ask a volunteer the day of the show for a disposal bag. We would like this as little of an inconvenience to others as possible. Please help us to make this show a success so we may do this again in the future.

This $15 dollars charge is to help with costs of the show and the rest will be donated to the Urbana Dog Park!

Registration after August 8^th 2004 will have an extra $5 charge.

Questions call Faith at (217) 643-2382

We will be in the Civic Center on Water Street.

We look forward to seeing you on August 28^th 2004. Please be there by 1:30 P.M. to check in.