Florida Gulf Coast Dachshund Club
Earthdog Test Entry Form
Fill out this form once for each dog entered. All fields are required.
Both your entry form(s) and your entry fees must have been received by 6:00 PM on Friday, March 1, 2019, to be considered timely as a pre-entry registration.
Name of Dog:
Date of Birth:
American Hairless Terrier
Dandie Dinmont Terrier
Glen of Imaal Terrier
Miniature Bull Terrier
Parson Russell Terrier
Smooth Fox Terrier
West Highland White Terrier
Wire Fox Terrier
AKC Reg #
AKC ILP/PAL #
AKC Litter #
Place of Birth:
Name of Actual Owner:
Test Entry Information
(if not owner)
Note: There are two events on Saturday and one on Sunday.
Entry for: (Check all that apply)
March 2, 2019
AKC Event #2019191503
March 2, 2019
AKC Event #2019191504
March 3, 2019
AKC Event #2019191505
ME & SE ($40)
ME & SE ($40)
ME & SE ($40)
AKC Rules, Regulations, Policies, and Guidelines are available on the American Kennel Club website at
Entry Fee Information
I will submit
for the entry fees above via:
PayPal - Send payment via PayPal using a bank account, credit card, or debit card
Bill Pay - Use the "bill pay" from your financial institution to pay your entry fees
Check - Write your own paper check and mail it to the Club Treasurer
I certify that I am the actual owner of this dog or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry, I (we) agree to abide by the rules and regulations of The American Kennel Club in effect at the time of this event, the standard procedures governing this Earthdog Test, and any additional rules and regulations appearing in the premium list or entry form for this event and any decisions made in accordance with them. I (we) acknowledge that the "Rules Applying to Registration and Dog Shows" and "Regulations for Earthdog Tests for Small Terriers and Dachshunds" are available to me (us) and that I am (we are) familiar with the contents. I (we) agree that the club holding this Earthdog Test has the right to refuse entry for cause which the club shall deem to be sufficient. In consideration of the acceptance of this entry and the holding of the Earthdog Test 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 Florida Gulf Coast Dachshund Club, its members, directors, governors, officers, agents, superintendents, or test 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 Earthdog Test premises or grounds, or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim. I (we) further agree that this dog is entered in and will be at this Earthdog Test at my (our) own risk and that I (we) will hold the Florida Gulf Coast Dachshund Club, its members, agents, and other aforementioned parties harmless from any claim for and free from liability for loss, injury, or damage to this dog including disappearance, theft, death, damage, or injury arising out of the entry of this dog or its presence at this Earthdog Test whether caused or alleged to be caused by the negligence of the Florida Gulf Coast Dachshund Club, its members, agents, or any of the other aforementioned parties, or the negligence of any other person, or any other cause or causes. I (we) hereby assume the sole responsibility for and agree to indemnify 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 or account of damage to property, arising out of or in consequence of my (our) participation in this Earthdog Test, however such injuries, death, or damage to property may be caused, and whether or not the same may have been caused or may have been alleged to have been caused by the negligence of the aforementioned parties or any of their employees or 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 THE EVENT-GIVING CLUB (UNLESS OTHERWISE STATED IN THIS PREMIUM LIST) 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.
An electronically submitted entry form shall be deemed to be signed by the authorized individual who includes his or her typed name on the line below identified as a signature. A valid email address is required to submit this entry form electronically.
SIGNATURE of Owner or Agent duly authorized to make this entry:
An event like the FGCDC Earthdog Test weekend requires many volunteers to help fill all the necessary jobs and make things run smoothly and efficiently. Would you like to be one of our valued volunteers and help with the Earthdog Tests?
Yes! - I would like to volunteer to help with the Earthdog Tests!
No - I will not be able to volunteer at the Earthdog Tests
Lunch will be available on site on Saturday and Sunday for a small donation. Please tell us how many people from your party you think will be joining us for lunch on
Entry Form Submission
If you would like a printed copy of your entry, please print from your browser before you submit this form.