Paws to Consider NADAC Trial 20-21 February 2021 at Werribee Park National Equestrian Centre Paws to Consider NADAC Trial Entry 20-21 February 2021 Entry form for PTC NADAC Trial to be held on 19-20 December 2020 at Werribee Park Equestrian Centre - Indoor 2 Step 1 of 6 16% Name* First Last Please enter your full name.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please provide us with your current residential addressPhone*If we need to contact you we generally use email but in case we need to contact you more urgently then a telephone number is helpful.Email* Enter Email Confirm Email Please provide us with a valid email address. All trial information will be sent to this email address.Emergency Contact* First Last In case we need to call someone due to an emergency (eg if you get ill or injured at the trial). Who would you like us to contact?Phone number for your emergency contact*How many dogs are you entering?* 1 2 3 4 This single form will allow you to enter up 4 dogs. If you have more than 4 dogs you will need to fill out an additional entry form.Do you want ribbons or trial credits?* Ribbons Trial Credits Please refer to the premium for details. 1. Dogs Call Name*Tell us your dog's name1. NADAC Registration Number*Please provide your dog's NADAC Registration number in the following format 00-000001. What is your dog's Date of Birth ?* MM slash DD slash YYYY 1.What is your dog's height at shoulder in inches ?*We use this information to determine jump height.1.What height do you want your dog to jump?*This information helps us help you.1. Handler's Name if not the owner of the dog First Last If your dog is being handled by someone else please tell us who that person is. If you are handling this dog you can leave this field blank.1. What Category are you entering this dog in?* Proficient Skilled 1. What Division are you entering this dog in?* Standard Veteran Dog Veteran Handler Junior Handler If you enter as a Vet Handler then you must enter Vet handler for all dogs entered.1. Saturday - Regular Agility - Round 1 Elite Level Open Level Novice Level Intro Level 1. Saturday - Regular Agility - Round 2 Elite Level Open Level Novice Level Intro Level 1. Saturday - Touch N Go- Round 1 Elite Level Open Level Novice Level Intro Level 1. Saturday - Touch N Go - Round 2 Elite Level Open Level Novice Level Intro Level 1. Saturday - Jumpers - Round 1 Elite Level Open Level Novice Level Intro Level 1. Saturday - Jumpers - Round 2 Elite Level Open Level Novice Level Intro Level 1. Sunday - Regular Agility - Round 1 Elite Level Open Level Novice Level Intro Level 1. Sunday - Regular Agility - Round 2 Elite Level Open Level Novice Level Intro Level 1. Sunday - Chances - Round 1 Elite Level Open Level Novice Level Intro Level 1. Sunday - Chances - Round 2 Elite Level Open Level Novice Level Intro Level 1. Sunday - Weavers - Round 1 Elite Level Open Level Novice Level Intro Level 1. Sunday - Weavers - Round 2 Elite Level Open Level Novice Level Intro Level 2. Dogs Call Name*Tell us your dog's name2. NADAC Registration Number*Please provide your dog's NADAC Registration number in the following format 00-000002. What is your dog's Date of Birth ?* MM slash DD slash YYYY 2. What is your dog's height at shoulder in inches ?*We use this information to determine jump height.2. What height do you want your dog to jump?*This information helps us help you.2. Handler's Name if not the owner of the dog First Last If your dog is being handled by someone else please tell us who that person is. If you are handling this dog you can leave this field blank.2. What Category are you entering this dog in?* Proficient Skilled 2. What Division are you entering this dog in?* Standard Veteran Dog Veteran Handler Junior Handler If you enter as a Vet Handler then you must enter Vet handler for all dogs entered.2. Saturday - Regular Agility - Round 1 Elite Level Open Level Novice Level Intro Level 2. Saturday - Regular Agility - Round 2 Elite Level Open Level Novice Level Intro Level 2. Saturday - Touch N Go - Round 1 Elite Level Open Level Novice Level Intro Level 2. Saturday - Touch N Go - Round 2 Elite Level Open Level Novice Level Intro Level 2. Saturday - Jumpers - Round 1 Elite Level Open Level Novice Level Intro Level 2. Saturday - Jumpers - Round 2 Elite Level Open Level Novice Level Intro Level 2. Sunday -Regular Agility - Round 1 Elite Level Open Level Novice Level Intro Level 2. Sunday -Regular Agility - Round 2 Elite Level Open Level Novice Level Intro Level 2. Sunday -Chances - Round 1 Elite Level Open Level Novice Level Intro Level 2. Sunday -Chances - Round 2 Elite Level Open Level Novice Level Intro Level 2. Sunday -Weavers - Round 1 Elite Level Open Level Novice Level Intro Level 2. Sunday -Weavers - Round 2 Elite Level Open Level Novice Level Intro Level 3. Dogs Call Name*Tell us your dog's name3. NADAC Registration Number*Please provide your dog's NADAC Registration number in the following format 00-000003. What is your dog's Date of Birth ?* MM slash DD slash YYYY 3. What is your dog's height at shoulder in inches ?*We use this information to determine jump height.3. What height do you want your dog to jump?*This information helps us help you.3. Handler's Name if not the owner of the dog First Last If your dog is being handled by someone else please tell us who that person is. If you are handling this dog you can leave this field blank.3. What Category are you entering this dog in?* Proficient Skilled 3. What Division are you entering this dog in?* Standard Veteran Dog Veteran Handler Junior Handler If you enter as a Vet Handler then you must enter Vet handler for all dogs entered.3. Saturday - Regular Agility - Round 1 Elite Level Open Level Novice Level Intro Level 3. Saturday - Regular Agility - Round 2 Elite Level Open Level Novice Level Intro Level 3. Saturday - Touch N Go - Round 1 Elite Level Open Level Novice Level Intro Level 3. Saturday - Touch N Go - Round 2 Elite Level Open Level Novice Level Intro Level 3. Saturday - Jumpers - Round 1 Elite Level Open Level Novice Level Intro Level 3. Saturday - Jumpers - Round 2 Elite Level Open Level Novice Level Intro Level 3. Sunday - Regular Agility - Round 1 Elite Level Open Level Novice Level Intro Level 3. Sunday - Regular Agility - Round 2 Elite Level Open Level Novice Level Intro Level 3. Sunday - Chances - Round 1 Elite Level Open Level Novice Level Intro Level 3. Sunday - Chances - Round 2 Elite Level Open Level Novice Level Intro Level 3. Sunday - Weavers - Round 1 Elite Level Open Level Novice Level Intro Level 3. Sunday - Weavers - Round 2 Elite Level Open Level Novice Level Intro Level 4. Dogs Call Name*Tell us your dog's name4. NADAC Registration Number*Please provide your dog's NADAC Registration number in the following format 00-000004. What is your dog's Date of Birth ?* MM slash DD slash YYYY 4. What is your dog's height at shoulder in inches ?*We use this information to determine jump height.4. What height do you want our dog to jump?*This information helps us help you.4. Handler's Name if not the owner of the dog First Last If your dog is being handled by someone else please tell us who that person is. If you are handling this dog you can leave this field blank.4. What Category are you entering this dog in?* Proficient Skilled 4. What Division are you entering this dog in?* Standard Veteran Dog Veteran Handler Junior Handler If you enter as a Vet Handler then you must enter Vet handler for all dogs entered.4. Saturday - Regular Agility - Round 1 Elite Level Open Level Novice Level Intro Level 4. Saturday - Regular Agility - Round 2 Elite Level Open Level Novice Level Intro Level 4. Saturday - Touch N Go - Round 1 Elite Level Open Level Novice Level Intro Level 4. Saturday - Touch N Go - Round 2 Elite Level Open Level Novice Level Intro Level 4. Saturday - Jumpers - Round 1 Elite Level Open Level Novice Level Intro Level 4. Saturday - Jumpers - Round 2 Elite Level Open Level Novice Level Intro Level 4. Sunday - Regular Agility - Round 1 Elite Level Open Level Novice Level Intro Level 4. Sunday - Regular Agility - Round 2 Elite Level Open Level Novice Level Intro Level 4. Sunday - Chances - Round 1 Elite Level Open Level Novice Level Intro Level 4. Sunday - Chances - Round 2 Elite Level Open Level Novice Level Intro Level 4. Sunday - Weaverss - Round 1 Elite Level Open Level Novice Level Intro Level 4. Sunday - Weavers - Round 2 Elite Level Open Level Novice Level Intro Level How many runs in total have you entered (total of all dogs and all runs)?*Runs cost $9.00 per run. You will be invoiced for your entry and the payment options are paypal or direct deposit. Instructions will be on your invoice as to how to pay.Is your entry Day of Show?* Yes No If your entry was received after entry close date and time the entry fee is $12.00 per run. Please refer to the premium for time and date of entry close.Trial Credit Notes Yes please apply any trial credits I may have No thanks i am saving them up and don't want to use them at this time You may have earnt Trial Credits from previous NADAC Trials would you like them applied to this entry. Your trial credits are stored on file with Paws to Consider. If you select yes and don't have any valid credits you will be invoiced the full amount for your entriesTrial Entry Agreement* I have read, understand and accept the terms of the trial entry agreementAGREEMENT The person who signs this agreement represents that he/she is authorized to enter into this agreement on behalf of both exhibitor and the owner of the entered dog. In consideration of the acceptance of this entry: 1.1. As used here "NADAC" means the North American Dog Agility Council, LLC. And NADAC Australia, its members,officers, directors, employees, show chairs, show committees and agents. 1.2. Exhibitor/owner agree to abide by the rules and regulations of NADAC and any other rules and regulations appearing in the premium for this event. 1.3. Exhibitor/owner certify that the entered dog is not a hazard to persons, dogs or property and that the entered dog's rabies vaccination is current in accordance with the requirement of the state in which the dog resides. 1.4. Exhibitor/owner acknowledge all hazards presented by the event and the event premises, including, but not limited to, the condition of the surface, restrooms, security measures or lack of, electrical appliances, fittings, show rings, parking areas and the presence of unfamiliar animals and people; exhibitor and owner assume the risk of any harm arising from these. 1.5. Exhibitor/owner releases NADAC (including its respective officers, directors, employees, and members), Paws to Consider (including its officers, directors, members, and event organizing committee), and Werribee Park National Equestrian Centre (including its officers, agents, and employees) and the Local, State and Federal Governments of Australia and will defend them and hold them harmless from all present and future loss, injury, damage, claims, demands and liabilities involving the entered dog, the event or event premises. Without limiting the generality of the foregoing hold harmless provisions, exhibitor/owner hereby specifically assumes sole responsibility for and agrees to indemnify and save the aforementioned parties harmless from any and all loss and expenses (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damages because of bodily injuries, including death, at any time in consequence of my (our) participation in this event, howsoever such injury or death may be caused and whether or not the same may have been caused or may have been alleged to have been caused by negligence of the aforementioned parties or any of their employees or agents or any other persons Email address of extra handler If you nominated an extra handler for any of your dogs we need their email address so we can ensure they complete a risk waiver and health declaration as part of our COVID safe planDo you need to tell or ask the trial secretary anything?Would you like to make a donation towards the 2021 NADAC Nationals?As part of our fundraising efforts towards the event costs of the Nationals, we are providing exhibitors with the option to donate throughout the year. Any amount donated is appreciated and will be included in your trial entry fee invoice.CAPTCHA