DECLARATION BY EXHIBITORS

I/We hereby certify that the dog/s entered overleaf is / are my/ our bonafide
For office use only property and I/we enter them at my/our own risk and the dog/s entered on this
th th th
form is/are registered in India ONLY, with the Kennel Club of India alone.
11 , 12 & 13 Championship dog shows
th st
On 20 & 21 November 2010.
I/We further declare that my/our champion dog / dogs has been only entered in
SINGLE DOG ENTRY FORM Breeds Obedience the champion class and not in any other class.

NAME OF EXHIBIT: I/We have read carefully the show schedule before filling this form and
undertake to abide by the Rules and current Regulations and Bye-laws of the
KCI REGN. No.: Kennel Club of India and of this Show and I/we declare that the dog/s entered
has/have not suffered from or been exposed to the risk of DISTEMPER or any
BREED:
contagious or infectious disease for the six weeks prior to exhibition and I/we
MICROCHIP NO:
will not show them if they incur such risk between now and the day of the
Show or if they have been inoculated with DISTEMPER VIRUS within fourteen
SEX: days prior to the Show.
COLOUR & MARKINGS:
I indemnify that; I will not hold The Kennel Club of India and Thrissur Canine
SIRE: Club responsible for the injury/loss and any such sort of damage to me/to my
exhibit or to my belongings during the show or later.
DAM:
I further declare that I am attending this event on my sole interest and not by
BREEDER: any means of influence whatsoever.

BRED IN INDIA IMPORTED DATE OF BIRTH: MODE OF PAYMENT

ENTERED IN CLASSES I am enclosing my entry for the Thrissur Canine Club’s 11th, 12th & 13th
CLASS AGE DOG BITCH championship dog shows/obedience trial as per following details:
MINOR PUPPY 4 to 6 MONTHS A G
PUPPY 6 to 12 MONTHS B H
Mode of remittance/
JUNIOR 13 to 18 MONTHS C I No. Breed Fee
D. D. Number
INTERMEDIATE 19 to 36 MONTHS D J
BRED IN INDIA IRRESPECTIVE OF AGE E K
D. D.
OPEN CLASS IRRESPECTIVE OF AGE F L
CHAMPIONS ONLY
CHAMPION CLASS M
(IRRESPECTIVE OF SEX)
Place: Signature
OWNERS
NAME
Date : Name :
OWNERS
ADDRESS

For Office Use Only

CITY STATE PIN

TELEPHONE NUMBER (Include STD Code)

Print my form
MOBILE NUMBER

E-MAIL ADDRESS

PLEASE READ THE SHOW SCHEDULE CAREFULLY BEFORE FILLING UP THIS FORM
All entries should accompany a clear Xerox copy of both sides of KCI registration certificate