Official Canadian Kennel Club Entry Form

EPS TRAINING ASSOC.

Wc-WCI-WCX TESTS, Sept 2,2017

ENTRIES OPEN AUG 9/17.
Advance entries Entries close Aug 23/17.
Mail entries to: Ivan Paul,
RR 4, Powassan, Ont., P0H 1Z0.

  
Entry Fee:$_____________    Listing Fee:$___________
A.M. test...............P.M. test...........

WC.............WCI.............WCX.............
BREED
REG. NAME OF DOG
Place of Birth    [___] Canada    [___]Elsewhere

Check one and Enter Number here:
[___]CKC Registration Number        
Date of Birth
Is this a puppy?

[___]Yes
[___]No

Sex ____
[___]CKC ERN Number [___]Day
[___]CKC Misc Cert. [___]Month
[___]Listed [___]Year
Breeder
Sire:
Dam:
Reg'd Owner
Name:
Address:
City: Prov: Postal Code
Name of Owners Agent:
Agent's Address:
City: Prov: Postal Code

I Certify that I am the registered owner(s) of the dog or that I am the authorized agent of the owner(s) whose name(s) I have entered aboveand accept full responsibility for all statements made in this entry. In consideration of the acceptance of this enty, I (we) agree to be bound by the rules and regulations of the Canadian Kennel Club and by any additional rules and regulations appearing in the premium list.

  Signature of Owner or Agent

                                                      
Email address:
                       
Telephone