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Official American Kennel Club Agility Entry Form

Saturday April 8 (rain date April 9)

Harvard’s K9 Center PO Box 1699 Crawford, AL 36868

334-298-0414 email: [email protected]

Two Rounds each of ACT 1 and ACT 2

PreTrial Registration Fees $15/run                       Day of Trial Fees $20/run

Junior handlers $10 per run


Dogs may be entered in any jump height. There is no Regular or Preferred distinction at AKC’s ACT events.

In order to acquire the ACT1 or ACT2 title certificate and have the title added to a dog’s record, the dog must be registered/listed with the American Kennel Club. AKC Canine PartnersSM applications may be accepted at the event and submitted to AKC with the event’s results.

Dogs that are not AKC registered/listed may be registered at a later date and receive their ACT title at that time.

AKC® NAME Dogs listed in the AKC Canine PartnersSM program should be listed as All American Dog and must include their AKC number on the entry form and select the AKC No. from the drop-down menu.

Junior Handlers should enter their Junior Handler Number on the front of this form. Should you not have your Junior Handler number, it may be obtained from the American Kennel Club (919) 233-9767. If the Junior Handler is not the owner of the dog identified on the face of this form, what is the relationship of the Junior Handler to the Owner?

Agility Course Test (ACT) - Select one jump height*

Check one or both rounds of a class level (ACT 1 or ACT 2)*



Height at Withers*

AKC Name*


Call Name*

Enter complete registration # below (if applicable)

Registration # Type

Date of Birth*

Place of Birth (List Country)*




Actual Owners*

Owners Address*




Handler (Junior Handler see below)

If Junior Handler, Please enter # below

Telephone Number*

Email Address*

In case of Emergency - Name:*

In Case of Emergency - Phone #:*


I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered. 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, and any additional rules and regulations published for this event and any decision made in accord with them and further agree to be bound by this Agreement. I (we) agree that the club or ACT Evaluator, holding this event has the right to refuse this entry for cause which the club or ACT Evaluator shall deem sufficient. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. In consideration of the acceptance of this entry and of the holding of this 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 event-giving club, their members, directors, governors, officers, agents, superintendents, event 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 or ACT Evaluator, 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 event premises or grounds or near any entrance thereto, and I (we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss, injury or damage to this dog. Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend 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 account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries, death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other person. 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) or ACT EVALUATOR 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

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