Applicant Name __________________________________________________________________________

Spouse's Name____________________________________________________________________________

Name(s) and Ages of children who will be or might be handling dogs. ___________________________________

Home phone ______________________________ Work or message phone ____________________________

Cell or Spouse's phone ______________________ Email Address ____________________________________

Home and Mailing Address___________________________________________________________________

________________________________________________________________________________________

Date of Birth __________________________Driver's License State and Number _________________________

Emergency Contact(s) and their Relation to You ___________________________________________________

Emergency Contact Number(s) ________________________________________________________________

Do you have a criminal record of any kind? If so, please explain.________________________________________________________________________________________

________________________________________________________________________________________________________________________________________

Please briefly describe your previous dog training experience & your level of expertise. In addition, if you have done helper work or are interested in being a helper, please mention this.

_________________________________________________________________________________________________________________________________

Please list all international, national or local dog clubs to which you belong. _________________________________________________________________________

_________________________________________________________________________________________________________________________________

What do you expect to gain from us, as a member of our club? What are your primary goals for yourself and for your dog(s)? __________________________________

_________________________________________________________________________________________________________________________________

Please list any practical skills you bring to the club, such as current CPR certification, First Aid or First Responder training, carpentry or construction skills, machine operation skills, artistic or design skills, or anything else that could be in any way pertinent or useful to the club.___________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________

List the dogs you will be working:

Dog's Registered Name:

Dog's Call Name:

Color: Sex: Age:

Level of training/titles received:

Date of last immunizations: DHLPP Rabies

Dog's Registered Name:

Dog's Call Name:

Color: Sex: Age:

Level of training/titles received:

Date of last immunizations: DHLPP Rabies

Dog's Registered Name:

Dog's Call Name:

Color: Sex: Age:

Level of training/titles received:

Date of last immunizations: DHLPP Rabies

Please list training goals for any and all dogs listed above:____________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

Primary Vet's name, clinic name & phone: _______________________________________________________________________________________________________

How did you hear about our club?_____________________________________________________________________________________________________________

This Application is for What Type of Membership ? FULL, FAMILY, ASSOCIATE, SATELLITE

Have you read and understood the bylaws of the Denali K9 Club? Please sign your name on the line below ONLY if you have read and understood the club bylaws.(Family members

must each sign individually if this is an application for a family membership.)________________________________________________________________________________

________________________________________________________________________________________________________________________________________

For all applicants, please list any and/or all dog club you are a member of, including yor and membership number and membership expiration date. examples of relevant dog sport clubs include the United Schutzhund Clubs of America, the German Shepherd Dog club of America-Working Dog Association, DG, Protection Sport Association and Ringsport associations. list individual Member Names and Member Numbers; _________________________________

________________________________________________________________________________________________________________________________________

TERMS OF AGREEMENT

I understand that my participation in this club is a deliberate choice I have made and, aware of the potential dangers associated with this sport, I assume all risk associated with said participation.
I will not hold this club, its officers, members, sponsors, land owners and other participants responsible for damage that may occur to my person or property as a result of the activities of this club.
I understand that the training of my dog is primarily for the purpose of the sport of Schutzhund. I am aware that Denali K9 Club events include the training and trials of dogs in dog protection sports.. I am familiar with such training and all of its components. I am aware that injury and harm to property and person, including potential dog bites, can occur in such a training environment. Knowing the risks, I hereby agree to assume those risks and to release and hold harmless all of the persons or entities mentioned above in the case of any harm, including situations of negligence on the behalf of other club members or officers of the Denali K9 Club..
I understand it is my responsibility to provide ample home-owner's insurance to cover the possible actions of my dog. I will provide a copy of my policy upon application for membership.
I understand that I am fully responsible and will be held responsible for the actions of my dog. I agree to keep my dog properly restrained and under reasonable control during training sessions. Failure to do so may result in disciplinary action, and repeated incidents may result in expulsion from the club to guard the safety of other club members and dogs.
I agree to treat my dogs and the dogs of others in a humane manner, as defined by this club and its officers. Purposeful harming of a dog is grounds for immediate expulsion from the club.Any inappropriate training or harming of a dog, if seen by a non-participating club member, must be reported to the training director immediately so that s/he may take appropriate action.Unintentional harming of an animal will dealt with by the Club officers on an individual basis and, depending on the degree of negligence involved and the injury sustained, will apply discipline throught appropriate and specific to the situation.
I understand that use of illicit drugs, or drunkenness, whether this drug use or inebriation occured before training or during training with Denali K9 Club, is grounds for immediate, permanent expulsion from Denali K9 Club, including future use of its training areas and participation/attendance at club trials and seminars .
I am familiar with, and agree to accept and abide by, the rules and bylaws of the Denali K9 Club and the national parent club..
I have neither falsified any information given nor have I withheld pertinent information from this application. I agree to all stated terms of Denali K9 Club membership.

Signature________________________________________________________________________ Date _________________________________________