              Official AKC Rally Virtual Entry Form

Official AKC Virtual ACT Entry Form
IMPORTANT Read the Instructions carefully before filling out the entry. Complete all of the required fields. The sire and dam are required if known. Next, be sure to read the Agreement and type your name in the signature box. Remember to add the correct ACT Course number and a working video link; then verify ALL the information is correct before you submit the form.

No form will be processed without your signature!!

Erroneous or incomplete entry forms will not be accepted and will have to be re-submitted in their entirety.

IF YOU NEED TO MAKE A CORRECTION TO AN ALREADY-SUBMITTED ENTRY, PLEASE DO NOT SUBMIT A NEW ENTRY FORM (THUS CAUSING A DUPLICATE ENTRY THAT NEEDS TO BE RESOLVED)! To make a correction, please send email to ACT@akc.org and reference Owner's Name, Dog's AKC Name, Dog's AKC #, and Course #.

Dog's Information
Breed:*
Sex:*
Full Name of Dog:*
Call Name of Dog:*
Registration Type:*
To obtain more information on registering your dog with The American Kennel Club, please send email to agility@akc.org
AKC Registration #:*
AB12345678 or PAL123456 Must include the appropriate letters. Do not use spaces, slashes or dashes.
Date of Birth:*

MonthDayYear
Place of Birth:*
Breeder:
Sire:
Dam:

Owner's Information
Actual Owner(s):*
Owner’s Address:*
City:*
State:*
Zip/Postal Code:*
Country:*
List country if not USA, else leave blank.
Phone Number:*
Format: 123-456-7890
Email Address *
An acknowledgement or receipt of entry will be sent to this email address.

Junior Handler Information (if applicable)
Name of Jr Handler:
List name of junior handler, else leave blank
Junior Handler #:
List number of junior handler, else leave blank.

ACT Class, Course, and Jump Height
ACT Class:*

ACT 1 StandardACT 1 JumpersACT 2 StandardACT 2 Jumpers
ACT 1 Standard Course Name:*
ACT 1 Jumpers Course Name:*
ACT 2 Standard Course Name:*
ACT 2 Jumpers Course Name:*
ACT Jump Height
At what Jump Height is your dog running the course?

ACT Video Course Submittal
INTERNET LINK from YouTube or similar sourceUPLOAD VIDEO FILE
Video Link Address:
Examples of proper links: https://www.youtube.com/watch?v=FrNZV_Zbqr0 OR https://youtu.be/Ciyenrzi9bM
File Upload

AVI, MOV or MP4 video file formats
Cancelof
*** Be sure to read the Agreement and sign below. No form will be processed without your signature! ***

INSTRUCTIONS
1. Either upload the video file from your computer OR provide the Internet Link for where your video may be viewed online for judging. If submitting a video file link, the privacy settings for this video must be set to allow anyone with the link to view the performance.

2. (Event Class) By submitting this entry form you agree that the dog entered is eligible for the ACT 1 Standard/Jumpers or ACT 2 Standard/Jumpers class.

3. A dog must be entered in the name of the person who actually owned it at the time the entry is submitted. If a registered dog has been acquired by a new owner it must be entered in the name of its new owner after the date of acquirement, regardless of whether the new owner has received the registration certificate indicating that the dog is recorded in his/her name. State on entry form whether transfer application has been mailed to the AKC. (For complete rules, refer to Chapter 11, Section 3.)

4.Dogs listed in the AKC Canine PartnersSM Program are eligible to submit AKC ACT Virtual Entries. These dogs should be listed as All American Dog and must include their AKC Number on the entry form and check the “AKC No.” box. Sire and Dam information shall remain blank for mixed breed entrants.

AKC Rules, Regulations, Policies and Guidelines are available on the American Kennel Club website: www.akc.org

AGREEMENT
I certify that I am the actual owner of the dog, or that I am the duly authorized agent of the actual owner whose name I have entered above. In consideration of the acceptance of this entry, I (we)agree to abide by the rules and regulations of The American Kennel Club in effect at the time of this event, and any additional rules and regulations appearing in the premium list of this event and entry form and any decision made in accord with them. I (we) agree that the club holding this event has the right to refuse this entry for cause which the club shall deem sufficient. I (we) certify and represent that the dog entered is not a hazard to persons or other dogs. In consideration of the acceptance of this entry and of the holding of this event and of the opportunity to have the dog judged and to win prizes, ribbons, or trophies, I (we) agree to hold the AKC, the event-giving club, their members, directors, governors, officers, agents, superintendents or event secretary and the owner and/or lessor of the premises and any provider of services that are necessary to hold this event and any employees or volunteers of the aforementioned parties,and any AKC approved judge, judging at this event, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog while in or about the event premises or grounds or near any entrance thereto, and I(we) personally assume all responsibility and liability for any such claim; and I (we) further agree to hold the aforementioned parties harmless from any claim for loss, injury or damage to this dog.Additionally, I (we) hereby assume the sole responsibility for and agree to indemnify, defend and save the aforementioned parties harmless from any and all loss and expense(including legal fees)by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at any time resulting therefrom, sustained by any person or persons, including myself (ourselves), or on account of damage to property, arising out of or in consequence of my (our) participation in this event, however such, injuries, death or property damage may be caused, and whether or not the same may have been caused or may be alleged to have been caused by the negligence of the aforementioned parties or any of their employees, agents, or any other person.

I (WE) AGREE THAT ANY CAUSE OF ACTION, CONTROVERSY OR CLAIM ARISING OUT OF OR RELATED TO THE ENTRY, EXHIBITION OR ATTENDANCE AT THE EVENT BETWEEN THE AKC AND THE EVENT GIVING CLUB (UNLESS OTHERWISE STATED IN THIS PREMIUM LIST) AND MYSELF (OURSELVES) OR AS TO THE CONSTRUCTION, INTERPRETATION AND EFFECT OF THIS AGREEMENT SHALL BE SETTLED BY ARBITRATION PURSUANT TO THE APPLICABLE RULES OF THE AMERICAN ARBITRATION ASSOCIATION. HOWEVER, PRIOR TO ARBITRATION ALL APPLICABLE AKC BYLAWS, RULES, REGULATIONS AND PROCEDURES MUST FIRST BE FOLLOWED AS SET FORTH IN THE AKC CHARTER AND BYLAWS, RULES, REGULATIONS, PUBLISHED POLICIES AND GUIDELINES.
I (we) certify that electronic typed signatures sent via email shall serve as original signatures.
Signature of owner and exhibitor:*
Date*

MonthDayYear
Date

Parent/Guardian Consent (if applicable)
I hereby certify that I am the parent or guardian of
a minor child under the age of 21 years, and I hereby consent to the terms set forth herein as they apply to the minor under my charge.
Signature of Parent:

Payment and Entry Submittal
AKC Virtual ACT entry fee:*
prevnext( X )
USDAs of 10/1/2024, entry fee is $30 for a single entry; additional entries must be submitted on their own, separate form with separate payment.
Please Scroll Up and Verify that all fields of data are what you intended to submit, including the Video Link fields. Please verify auto-fill has not changed the data from what you originally intended!

CLICK THE reCAPTCHA BELOW TO VERIFY YOU ARE A HUMAN, SELECT A PAYMENT TYPE, THEN CLICK SUBMIT TO PROVIDE PAYMENT AND COMPLETE YOUR ENTRY.

ONCE YOUR ENTRY HAS BEEN REVIEWED, WE WILL ASSIGN AN AKC LICENSED AGILITY JUDGE TO REVIEW YOUR RUN, THEN SEND AN EMAIL WITH YOUR SCORED RESULTS.

It is currently taking 4-6 weeks to get emailed scored results back to the exhibitor.
Click Here:*

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Official AKC Virtual ACT Entry Form