Form: ___________

Ex. No: _________

Form: ___________

Ex. No: _________

ENTRY FORM

ENTRY FORM

18th & 19th Gurgaon Kennel Club, KCI Championship
Dog Shows

18th & 19th Gurgaon Kennel Club, KCI Championship
Dog Shows

To,
Mr. Sanjay Kapoor
Hony. Show Secretary
Gurgaon Kennel Club
968, Sector 14, Gurgaon 122001
+91-9810260981

All Names should be clearly written or typed in block letters.

All Names should be clearly written or typed in block letters.

Dear Sir,

Registered Name: _____________________________

Registered Name: _____________________________

I am enclosing my entries for the 18th & 19th Gurgaon
Kennel Club, KCI Championship Dog Shows as per following
details:

KCI Registered No.: _______________ Sex: ________

KCI Registered No.: _______________ Sex: ________

Total Number of Dogs of one owner on this form:

Microchip No.: ________________________________

Microchip No.: ________________________________

Rs. 1000 /- per dog for 18th and 19th Championship Dog
Show. Price includes catalogue cost

Breed: ______________________________________

Breed: ______________________________________

Colour & Marking: _____________________________

Colour & Marking: _____________________________

Sire: _______________________________________

Sire: _______________________________________

Dam: ______________________________________

Dam: ______________________________________

No.

Breed/Class

Fee

1.

________________

Rs __________

2.

________________

Rs __________

Total

Rs __________

Total (in Words) Rupees ___________________________

Bred in India / Imported

Bred in India / Imported

Date of Birth: _________________________________

Date of Birth: _________________________________

_________________________________________________
Read the schedule & K.C.I regulations carefully.

Entered in Classes: ____________________________

Entered in Classes: ____________________________

DECLARATION BY THE OWNER

Breeder: ____________________________________

Breeder: ____________________________________

Owner’s Name: _______________________________

Owner’s Name: _______________________________

I/We HEREBY CERTIFY that the dog/s entered above is/are my/our
bonafied property and I/WE enter them at my/our risk, and that the dog/s
entered on this form is/are registered in India ONLY with the Kennel Club
of India alone.

Address: ____________________________________

Address: ____________________________________

____________________________________________

____________________________________________

City: ______________________Pin:_____________

City: ______________________Pin:_____________

Tel Mobile: _________________________________

Tel Mobile: _________________________________

E-mail: ____________________________________

E-mail: ____________________________________

Date Signature

Date Signature

All entry forms must be accompanied by a clear photocopy of
The KCI Registration Certificate. Exhibitors need to fill only
one form per dog.

ENTRIES CLOSE on 15 Dec 2012
LATE ENTRIES will be accepted till 20 Dec 2012 @ Rs. 1500
per dog for both shows

I/WE further declare that our champion dog/dogs has been only entered in
the champion class and not in any other class.
I/WE undertake to abide by the Rules and Regulations and Bye-Laws of
the Kennel Club of India and of this Show and I/We declare that dogs
entered has/have not suffered from or been exposed to the risk of
DISTEMPER or any contagious or infectious disease for six weeks prior to
exhibition, and I/We will not show them if any incur such risk between now
and the day of the Show, or if they have been inoculated with DISTEMPER
VIRUS within fourteen days prior to the Show.
I further undertake that the Gurgaon Kennel Club shall not be liable for any
Infection, illness, injury or loss of life caused to the exhibitor or exhibit
because of participation in the show.

Signature:
Name:
Address:

Date: