C DECLARATION BY NOMINATING SOCIETY (IF APPLICABLE) PLEASE COMPLETE IN BLOCK CAPITALS AND INK

The Committee of the I I I I I I I I I I I I I I I I I I I I I I I I I I I I

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

having considered the information given in this questionnaire, forward this nomination for the consideration of the Kennel Club.

SIGNATURE OF SECRETARY DATE FORWARDED I I I I I I I

Please see reverse of form for relevant judging qualifications.

KENNEL CLUB QUESTIONNAIRE FOR PROPOSEDCHAMPIONSHIP AGILITY JUDGE

JD11

FOR KENNEL CLUB USE

DATE OF RECEIPT APPROVED YES NO DATE OF COMMITTEE MEETING

B DECLARATION BY NOMINEE PLEASE COMPLETE IN BLOCK CAPITALS AND INK

MR/MRS/MISS/MS I I I I I NAME I I I I I I I I I I I I I I I I I I I I I I

ADDRESS I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

POSTCODE I I I I I I I I I I I I I I I I I I I DATE OF BIRTH* I I I I I I I

TEL NOI I I I I I I I I I I I I I I I FAX NO I I I I I I I I I I I I I I

EMAIL I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I II hereby declare that the information given is correct, and if, at any time, altered circumstances render my replies no longeraccurate, I undertake to notify the Committee of the Kennel Club immediately.I undertake to familiarise myself with the Kennel Club Regulations and Kennel Club Guide for Agility Judges, and judge according tothem.* N.B. Personal details marked with * will be kept confidential. All other information will be used for an information database. If you DONOT wish your name and contact details to be published either in printed or internet format, please tick this box. A tick will prevent yourdetails being published in the next Championship Show Judges Directory. This form should be submitted at least eighteen months prior to the date of the show

SIGNATURE DATE I I I I I I I I

A NOMINEE’S DETAILS PLEASE COMPLETE IN BLOCK CAPITALS AND INK

MR/MRS/MISS/MS I I I I I NAME I I I I I I I I I I I I I I I I I I I I I I

I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

AGILITY CHAMPIONSHIP LARGE DOG INTERMEDIATE DOG MEDIUM DOG SMALL DOG (Please tick box(es))

* SOCIETY (if applicable) I I I I I I I I I I I I I I I I I I I I I I I I I I I I

I I I I I I I I I I I I I I I I I I I I I I DATE OF SHOW I I I I I I I

In order that the Committee of the Kennel Club can consider your nomination to judge at the above Show, will you please give afull reply to all the questions on this form and return it at your earliest convenience. * If no nominating society, leave blank.

NB. All first time appointments must be applied for a minimum of eighteen months before the date of the trial on the formprovided

JD11 VERSION 10 MARCH 2020

3. Have you attended a seminar run by a Kennel Club Accredited Trainer (Agility) and passed the Kennel Clubexamination on Regulations and Judging Procedure (Agility)? YES NO (Please tick box)

Date of examination: Name of Trainer:

1. Date commenced judging at Agility Shows:

2. Date commenced competing at Agility Shows:

4. Have you attended a seminar run by a Kennel Club Accredited Trainer (Agility) and passed the Kennel Club assessment on Course Design and Judging? YES NO (Please tick box)

Date of examination: Name of Trainer:

NAME OF DOG SOCIETY SHOW DATE CLASS PLACE

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Please continue on a separate sheet if necessary

5. Please list below details of Agility Shows at which you have competed.

NAME OF SOCIETY SHOW DATE CLASS - INCL HEIGHT OF DOGS NO. OF DOGS ENTERED

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

Please continue on a separate sheet if necessary

6. Please list below details of all Agility Shows at which you have judged.

The Kennel Club, Clarges Street, London W1J 8ABTelephone 01296 318540www.thekennelclub.org.uk

All information is correct at time of printing

Kennel Club Agility Regulations H paragraph 19 – Minimum judging experience required for Agility Championship Large /Intermediate / Medium / Small Dog at Championship Agility Shows

7. Please list below details of all future judging appointments.

NAME OF SOCIETY SHOW DATE CLASS (WHERE KNOWN)

1

2

3

4

5

6

7

8

9

10

Please continue on a separate sheet if necessary

On application for a person’s first appointment to judge the Championship Agility Class the minimumconditions which apply are:-

1) The person must have:

• a minimum of 5 years’ experience of competing at Kennel Club licensed Agility Shows, and• a minimum of 5 years’ experience of judging at Kennel Club licensed Agility Shows, and• judged at a minimum of 10 licensed Agility Shows over the previous 3 years including standard classes ineach height category which must include Grade 7 class(es) (size of classes judged and their geographicaldistribution will also be considered), and

• have judged Kennel Club qualifier(s) for Crufts, Discover Dogs, or Olympia, and• handled a dog competitively at Grade 6 or 7, and• attended a Kennel Club Agility Regulations and Judging Procedure seminar and passed the Regulations andJudging Procedure examination, and

• attended a Kennel Club Agility Course Design and Judging Seminar and passed the assessment.

2) The person must have been assessed when judging grade 6 or grade 7 Agility classes before beingapproved for their first Championship appointment; details of future judging appointments should beprovided on this form to enable the Kennel Club to arrange an assessment.

NOTE: A person approved to judge a Championship Agility Certificate may not judge another ChampionshipAgility Certificate at the same height category within a period of six calendar months.