DarnFar Ranch
 

RR1, Box 114, Brownstown, IL 62418             (618) 427-3333 or 292-9427                  darnfar@frontiernet.net

May 13, 2007

NOTE:  THIS IS A RESCHEDULED DATE as of 4/10/07

American Kennel Club

Canine Good Citizen (CGC) Test

Starting at 12:00 PM*  - Ending when all tests are complete

Tester: Denny Van Hook

Fee:  $5.00  / dog  (make checks payable to DarnFar Ranch)
 
Fill in one form per dog entered.
CGC Test information can be found at http://www.akc.org/events/cgc/index.cfm   

 

Name:

Dog’s Name:

Address:
Age:  

Sex:

 Male   or   Female

City, State, zip:
Breed:   Neutered? Y  or N

Telephone:

Has this dog ever bitten anyone?        Yes     No

Email:

Veterinarian:

Date Distemper/Parvo vaccine Expires:

Vet’s Address:

Date Rabies vaccine expires:

To protect your dog and the others in this event, accurate records of your dog's vaccination due dates  are required for participation.   Please provide a hard-copy record of your dog's vaccination with this entry form.

How did you hear about CGC Testing at DarnFar?   __Vet   __Groomer    __Kennel    __Friend    __Flier w/ Pull Tabs   __New Paper Ad    __ Other

I understand that participating in dog training has some risk of injury to myself and my dogs(s). I consent and willingly agree to assume any and all risks involved in dog training, including any type of accident, damage or any personal bodily injury to myself, or to my dog, friends or family members I might have brought to the event. I further agree that I will hold Tammie and Robert Rogers, Lisa Pellum and any assistants  harmless and defend them from any and all liability for any injury, claim, damage or loss of whatever kind, which may be caused by me or any dog or family member I have brought to DarnFar Ranch or other training locations where classes are administered by Tammie Rogers. I certify and represent that my dog(s) are currently inoculated against communicable canine diseases and are free of communicable parasites. I certify and represent that that the dog(s) I bring to dog events are not a hazard to other dogs or people.

Signature: ______________________________________________________ Date: _________________