Voorzitter: Dhr - Rottweiler Werkgroep Flevoland

President: mr. .M.Montes Klaver
Treasurer: Mr.J.H.van Loenen/Mr.L.A.de Vries
Secretary: Mr. R.Mangold
Address: Pereboomweg 103
1326 DX Almere
The Netherlands
E-mail: [email protected]
NRC ROTTWEILER WERKGROEP FLEVOLAND
Nederlandse Rottweiler Club
KvK 40656462
Entry Form
PERMISSION TO COPY GRANTED
Entry form for the 16th Anniversary of the Piet Hein Bokaal - IPO CACIT trial in Almere, for Rottweilers only,
hosted by the NRC Rottweiler Werkgroep Flevoland
Closing Date: JUNE 20, 2014
Name of the Dog……………………………..……………………………………………………
Chip or tattoo……………………………..……………………………………………………
DOB of the dog …………….………..……..Male/Female*…………..…………………………
NHSB or foreign registration #:……….………………………………..…….
Name of sire: ……………………………………………………………………………………….
Name of dam: …………………………………………………………………………………….
Name of breeder: ………………………………………………………………..……………….
Name of owner: …………………………………………………………………..……………….
Name of handler:………………………………………………………………………………….
Address: ………………………………………………………………………………….………..
Postal Code:………….…………City/town:……………………………………………..………...
Telephone number:…….……………………………….E-Mail:……………….……………….
Name of the Rottweiler training club you are a member of:
……………………………………………………………………………………………………….
PLEASE MAIL TO:
[email protected]
The entry fee will be € 25,00 .
I (we) the owner(s)/agent(s) of the dog named above duly certify that the dog entered has not been exposed
to any transmissible diseases within the last 12 weeks, and following through to the day of the trial.
I (we) the owner(s)/agent(s) of the dog named above agree to duly abide by the Constitution & Bylaws of
the Raad van Beheer. The NRC Rottweiler Werkgroep Flevoland reserves the right to refuse an entry from
anyone without further explanation.
I (We) agree to hold this club, its members, directors, governors, officers, agents, show secretary and the
owner or lessor of the premises and any employees of the aforementioned parties, 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 upon the show or trial premises or ground 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 for damage or injury to the dog, whether such loss, disappearance, theft,
damage or injury, be caused or alleged to be caused by the negligence of the Club or any of the parties
aforementioned, or by 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 hold 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 there from, 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 trial, howsoever such
injuries, death or damage to property may be caused, and whether or not the same may have been caused
or may be alleged to have been caused by negligence of the aforementioned parties or any of their
employees or agents, or any other persons.
Notice: all foreign entries must bring ORIGINAL proof of rabies vaccination, registration and
scorebook on the days of the trial.
Date:………………………….………..
Signature of owner/agent:………………………..…………………………………...
Family name in capital/writing letters………………………………………..

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