HUNDESPORT ALASKA, INC.

APPLICATION FOR MEMBERSHIP

Applicant Name______________________________________________

Street or P.O. Box___________________________________________

City, State, ZIP______________________________________________

Email_______________________________________________________

Home Telephone ____________________

Work Telephone__________________

Spouse Name________________________________________

Family Membership _____  Single Membership _____ 

Junior Membership _____ 

Affiliate Membership _____

United Schutzhund Clubs of America number and expiration date___________________________________________  

What is your dog training experience? Include academic training, seminars and/or workshops, certifications, etc.

Memberships in other dog/training groups.

Why do you want to join Hundesport Alaska, Inc.?

What do you expect to gain from your membership?

What do you have to offer Hundesport Alaska, Inc.?

List all dogs you will be training/working with Hundesport.

Breed_________________________ Call Name_________________________________

Registered Name____________________________________________________

Sex: Male Female Spayed/Neutered? Yes No Date of Birth___________________

Registry and Registration Number____________________________________________

Titles_____________________________________________________

Veterinarian Clinic Name___________________________________________________

Vaccination Dates: DHL/Parvo ________________Rabies________________________

OFA, "a" Stamp, etc.______________________________________________________

Sire___________________________________________

Titles_____________________

Dam__________________________________________

Titles_____________________

Breeder_________________________________________________

Breed _________________________Call Name_________________________________

Registered Name__________________________________________________

Sex: Male Female Spayed/Neutered? Yes No Date of Birth___________________

Registry and Registration Number____________________________________________

Titles____________________________________________________

Veterinarian Clinic Name___________________________________________________

Vaccination Dates: DHL/Parvo ________________Rabies________________________

OFA, "a" Stamp, etc.______________________________________________________

Sire___________________________________________

Titles_____________________

Dam__________________________________________

Titles_____________________

Breeder__________________________________________________

Training Agreement and Understanding of Liability

1.      I understand and agree that my participation in Hundesport Alaska, Inc. is at my own risk.

2.      I understand that I am responsible for the actions of my dog(s) and agree to keep my dog(s) properly restrained at all times.

3.      I agree to hold United Schutzhund Clubs of America and Hundesport Alaska, Inc., its officers, directors and members, as well as any ground or property owners, harmless for loss or injury to any person, dog, or things, and by any action of my dog(s) while on the training/trial/seminar grounds. I agree to personally assume all responsibility and liability for any such claim.

4.      I understand that the training of my dog(s) is primarily for the purpose of schutzhund.

5.      I understand that schutzhund training is a sport. It is not "protection" or "guard dog" training.

6.      I agree to abide by the Constitution and By-laws of Hundesport Alaska, Inc.

7.      No refunds or substitutions for any fees paid shall be allowed.

______________________________________ ________________

Signature of Applicant                                             Date

______________________________________ _________________

Signature of Applicant/Legal Guardian                     Date

______________________________________ _________________

Member Sponsor                                                   Date

______________________________________ _________________

Member Sponsor                                                   Date

For treasurer:

Application: Accepted _____ Denied_______Date:___________

Application Fees Paid:____________________

MonthlyDuesPaid:_______________________

Total Fees Paid:__________________________

Probation Period Ended: __________________

Paid by: check___   cash _______