APPLICANT INFORMATION
Member
Name:__________________________________________________________
Home E-Mail:_____________________ Work E-Mail
:________________________
Telephone: Home______________Work
________________Mobile_____________
Address:______________________________City___________State____Zip________
USA Member? (required):____No/Yes_______USA Member
Number:_____________
DOG INFORMATION
Dog Full
Name:______________________________________Breed:________________
Age:______Titles:____________Pedigree___(please
attach) __________
Vaccination Record:_____________(please attach
record)_______________
LIABILITY STATEMENT
I agree to hold harmless any property
owners, members,
officers, or others affliated with the Chattahoochee Schutzhund
Association
of any claim for the loss or injury that may be alleged to have
been
caused by any person or dog. I agree that I personally assume all
responsibility for my actions and for the actions of my
dog(s).
Signature:_____________________________________Date:____________________
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