USCA Club Trial
Mid Central Illinois Sch Club
October 1 & 2, 2016
USCA Al Govednik
Held in OG Indianapolis
Plumber’s Union 3747 High School Rd. Indianapolis, IN
Entry Form:
Please circle the appropriate entry category:
Trial: BH IPO1 IPO 2 IPO 3 Other______
Entry fee is $75 for IPO / AWD Titles and $50.00 for BH, TR 1‐3, OB 1‐3
See information at bottom of page for deadlines and where to send entries
Make checks payable to OG Indianapolis
Non USCA Members please add $25.00 processing fee to entry fee. Sorry no refunds.
Dog's registered name:______Titles:______
Breed:______Date of Birth:______Sex:______Tattoo / Chip #______
American Bred: __Yes __ No Handler Owned & Trained: __Yes __No
Registration Organization: ______Registration # ______
Scorebook Organization: ______Scorebook # ______
Sire: ______Titles: ______
Dam: ______Titles: ______
Organization Represented:______
Membership #: ______Training Club Affiliation:______
Owner: ______Phone Number: ______
Handler: ______Phone Number:______
Address: ______E‐mail: ______
City: ______State: ______Zip Code: ______
Send entry along with payment to:
Carolyn Daniel
823 E. Elm
Hoopeston, IL 60942
For questions call Mike Diehl at 317‐677‐3417 or email at
Deadline for entries September 23, 2016 Late entries accepted with $25.00 extra fee.
Please read carefully: It is hereby understood that every dog at this event will be under the direct care and control of its handler. The undersigned agrees to be fully responsible for any and all actions of their dog, including dogs owned by another but in the undersigned’s care, and to hold harmless all members, officers and directors of the OG Indianapolis Schutzhund and Police Club, and any property owners associated with this event in case of accident, injury or death, either to oneself or one’s dog and loss of property. The undersigned also, by signing hereunder, grants to sanctioned photographers and videographers a royalty free license to use his or her image, or the image of his or her dog, in promotional videos or highlights videos for sale, etc. Any and all protests must be submitted in writing to a member of the trial organizing committee at the event only. No protests will be heard after the closing ceremony and all decisions concerning any protests will be made by the time of the closing ceremony and shall be final. OG Indianapolis Schutzhund and Police Club shall not bear the responsibility to review such grievance but will attempt in good faith to, time permitting. Its response need not be in writing at the time it is made but will be provided upon a written request for same within ten (10) business days. I, the undersigned, do hereby assume all responsibility and liability for myself and my dogs and agree to abide by all USCA guidelines and rules and agree, irrevocably, to all of the above:
Owner/Handler/Agent: ______Date: ______