Official Registration Form
                         Action Dog Association
Action Dog Registration form

ADA Dog#.                                                                                                                       ADA Handler#

Handler Full Name:

Dog’s Name                                                                                                                      Dog Breed




City                                  State                              Zip

AKC#                                       UKC#                                       CKC#                                                   IKC#

Vet of Record:                                                                                                                         phone#

Class of Entry

(B).   (N).   (A).   (A1).   (E).   (E1)

Basic Rules Dog and handler must find their required items, in the allotted time. Judges record is final.

I have read the guide book and understand the detail rules of the sport of Acton Dog?

Sportsman Like Conduct , handler will be kind to dog, and conduct themselves in a respecting manner with each other.

Hold ADA harmless in the event of negative dog to dog, or human interaction, accident or injury.

__Event Fee $10.00, club may have additional fee added.

One time Registration Fee

__Dog Registration Fee $5.00 or

__Handler Registration Fee $10.00

Amount Paid ________________  

______________________________________.                       ______________________________________________

Print Name                                                                                            Signature and Date

ADA verification  INT__________