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Please complete sections 1 to 7. It is your own interest to write clearly to avoid possible mistakes.

SECTION 1 Name

Address

Telephone No

Email

To enable your application to be considered, please give a full reply to all the questions on this form. If there is a section where you have no information to inset – then please write NONE. The judging lists criteria can be obtained from our website, Hon Secretary or Judging List Administrator. When your judging questionnaire is completed you should sign the declaration and return the form to the address given in the box below.

The Shih Tzu Club of South Wales &

Western Counties Please return this questionnaire to:

Mrs Tracey Hitt 11 St Stephens Avenue

Pentre Rhondda Cynon Taff

CF41 7DF Email: tracey.hitt@btinternet.com

INFORMATION IN THIS FORM IS CONFIDENTIAL TO THE

SHIH TZU CLUB OF SOUTH WALES & WESTERN COUNTIES SECTION 2 – General Information How long have you been interested in Shih Tzu as:

AN EXHIBITOR: A BREEDER:

A JUDGE:

Do you hold a Kennel Club registered Affix If yes please state what it is

YES/NO

Please give the names & KC Stud Book numbers of Shih Tzu which were bred by you or owned by you when they obtained their first entry in the Kennel Club Stud Book by reason of their wins

KC Registered Name

KC Stud Book No

Shih Tzu Breed Club & Society’s Judging Questionnaire

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SECTION 3 – INFORMATION ABOUT YOUR JUDGING OF SHIH TZU Give below the names & dates of all Show, in the UK only, at which you have judged classes of Shih Tzu. Please list the appointments in chronological order. Documentary evidence of entries may be required and must be provided if called upon. You may include future UK appointments that have been confirmed in writing to you. You may photocopy this page if you require more space. If you have judged Shih Tzu OVERSEAS, please photocopy this page and list your OVERSEAS appointments separately. Please remember to print your name on any extra pages and sign & date them. Name of Club/Society holding the Show Date of

Show Type of show (e.g. Open)

No of breed classes actually judged *

No. of Shih Tzu entered **

Actual No. of Shih Tzu present and judged ***

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Totals

* Only include classes in which dogs were present – not simply those scheduled ** The total number of Shih Tzu entered not the number of entries *** This requirement is for all shows held after 1.1.1995

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SECTION 4 – INFORMATION ABOUT JUDGING OTHER BREEDS & VARIETY CLASSES: Do you award Challenge Certificates in any other breed? If yes, please state which breed (You may attach an additional page if your require more space)

YES/NO

Have you been approved by the Kennel Club to judge a Group If yes, please state which Group

YES/NO

Give below the names and dates of Shows in the UK at which you have judged classes of other breed and variety classes. You may include future UK appointments that have been confirmed in writing to you. You may photocopy this page if you require more space or add additional pages. If you have judged other breeds and variety classes OVERSEAS please photocopy this page and list your overseas appointments separately. Please remember to print your name on any extra pages and sign & date them. Name of Club/Society holding the Show

Date of Show

Type of show (e.g. Open)

Breed Type or Variety

No. of classes actually judged *

Actual No. of dogs present and judged **

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Totals

* Only include classes in which dogs were present, not simply those scheduled ** This requirement is for all shows held after 1.1.1995

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SECTION 5 – SHOW CRITIQUES As a Judge at a Championship Show or Breed Club Open Show, do you agree to produce a written critique for the first two placing’s in each class & also agree to dispatch the critique to at least one of the weekly UK canine journals – all as required by the Kennel Club?

YES/NO

SECTION 6 – FURTHER INFORMATION ABOUT YOUR TRAINING The following information is an important part of your application. Please remember to put your name at the top, sign & date the any additional pages. Please supply all further information concerning any training you have undertaken or your other experience in Shih Tzu that serves to prove your depth of interest in the breed. Have you attended the ‘Requirements of a Dog Show Judge’ seminar run by a KC Accredited Trainer? If yes, did you pass the examination? If yes, please attach a copy of your Certificate

YES/NO YES/NO

Have you attended the ‘Conformation and Movement’ seminar run by a KC Accredited Trainer? If yes, please attach a copy of your Certificate

YES/NO

Have you passed a ‘Conformation & Movement Hands On Assessment’ run by a KC Accredited Trainer? If yes, please attach a copy of your Certificate

YES/NO

Have you attended any Breed Specific Seminars held by the Shih Tzu Breed Clubs/Society’s? If yes, please attach a copy of your Attendance Certificate(s)

YES/NO

Have you attended any KC recommended Shih Tzu specific assessments/seminars that are organised by the Shih Tzu Breed Clubs/Societies in accordance with the Kennel Club JDP recommendations? If yes, please attached a copy of your Certificate

YES/NO

Have you attended a Stewarding Seminar? If yes, please attach a copy of your Attendance Certificate

YES/NO

Have you attended any other Seminars, which serve to prove your depth of interest in Shih Tzu? If so, please list on a separate sheet & attach a copy of your Attendance Certificate(s)

YES/NO

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SECTION 7 – DETAILS OF YOUR STEWARDING EXPERIENCE AT OPEN OR CHAMPIONSHIP SHOWS Existing CC Judges do not need to the complete this section. Please record your details below. You may be required to proved photocopies of any stewarding certificates or Kennel Club Stewarding Record Book to support your application. Name of Club/Society holding Show Date of

Show Type of Show

Breed Type Or Variety

No of classes actually stewarded

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DECLARATION OF APPLICANT: I________________________________________ (print your name) hereby declare that the information I have given is correct. If at any time, altered circumstances render my application inaccurate, I undertake to notify the Shih Tzu Tzu Club of South Wales & Western Counties immediately. In making this application to be included on a judging list, I agree to the information being stored on computer. A also agree that my name, address and telephone number can be included in the lists that will be distributed by the Shih Tzu Club of South Wales & Western Counties. Signed:___________________________________________________ Date: ________________________