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PURCHASE AREA HUNTING RETRIEVER CLUB    
PAHRC Online Premium
PURCHASE AREA HRC
Hunt Test Premium
May 5th & 6th
I submit $_____________ for entry fees.   One entry form per dog, per day.

Enter in stake/test:  Started______ Seasoned_______ Finished_______

Enter in Hunt Day:     Saturday______   Sunday______

(PLEASE PRINT CLEARLY)

Registered Name of Dog:______________________________________

Call Name:________________ UKC Registration #:_________________

UKC Points:________(optional)      BREED:________________________

Male:____  Female:____   Date of Birth: _______________

Sire:_____________________________________________________

Dam:_____________________________________________________

Breeder:__________________________________________________

Name of Registered Owner:___________________________________

Owner's HRC #____________ (optional) Home Club:_______________

Owners Address:___________________________________________

City:________________________ State:__________ ZIP:_________

Phone#:_____-_____-_________ EMAIL Address:________________

Name of Handler:___________________________________________

I certify that the above dog's communicable disease
Immunizations are current:

Owner Siganture:____________________________________
(registered Owner or His'Her Handler Duly Authorized to make this entry)

Handlers Address (if Handler signs Above Line for Registered Owner)

Address:_________________________________________________

City:______________________ State:________ ZIP:____________

Phone#:____-_____-________ EMAIL Address:_________________

HRC Membership Affiliation:______________________ optional

HRC Membership #_____________________________ optional

I agree NOT to hold the landowner(s) responsible for loss of property,
damage or injury incurred during this event. UKC and the host Club
are not responsible for loss, accident or theft. UKC and the host
Club assume no responsibility for any damage or injury sustained by
the exhibitors, or to any of their dogs or property and further assume
no responsibility for injury to children not under the control of their
parents or gaurdians.