COCKER SPANIEL PEDIGREE SUBMISSION FORM

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After you have completed the form, click on Top Of Page to go back and
verify your information before clicking on SUBMIT INFO.

After Submitting the information, an email will be generated sending the information to our Pedigree department.
It may take several days for us to add your information. Thank you for submitting your information.

YOUR INFORMATION

Please enter your E-MAIL address. REQUIRED FIELD
An invalid e-mail address will cause the information submitted to not be added to our database.
Please enter your REAL name. REQUIRED FIELD
NOTE: This information is for our records ONLY

DOG INFORMATION

REGISTERED NAME OF DOG REQUIRED FIELD
(Do NOT include titles) Maximum characters is 80
CALL NAME
Max characters 40
Please select the sex of the dog.
REQUIRED FIELD 		MALE FEMALE
If the dog has been bred, please indicate the
STUD BOOK Entry Date: (Format is MM-YYYY)
Whelped REQUIRED FIELD
Format MM-DD-YYYY
AKC Registration Number
Max characters 25
Additional Registration Number
Max characters 25
Additional Registry (CKC, UKC, APRI, etc.)
Max characters 30
Additional Registration Number
Max characters 25
Additional Registry (CKC, UKC, APRI, etc.)
Max characters 30
Select 1 (one) of the following colors.
Select the appropriate PATTERN. MERLE SABLE
Please enter any additional information describing
the color/pattern for this dog.
TITLES

Please enter ALL titles for this dog. (Titles PRECEED the name)
Titles such as Am Ch, Can Ch, GCh, Int, etc.
Max characters 80
Please enter ALL awards for this dog (Awards listed AFTER the name)
Awards such as CD, RN, AJP, etc.
Max characters 80

HEALTH TESTS PERFORMED


If this dog has had hip x-rays completed, please indicate which test was performed, certificate number issued
and date test was performed.
Test Performed

Cert#

Date: (Format is MM-DD-YYYY)


If this dog has had eyes checked by a qualified opthomologist, please indicate the CERF number,
status (Clear, etc.) and date.
CERF#

Status:

Date: (Format is MM-DD-YYYY)


BREEDER(S) & OWNER(S)


Please indicate the name(s) of the breeder(s). Seperate names with a comma.




Please indicate the name(s) of the owner(s). Seperate names with a comma.




SIRE & DAM


Please list the SIRE including any TITLES:
REQUIRED FIELD
SIRE :



Please enter the SIRE REGISTRATION NUMBER.
SIRE REG NO:



Please list the DAM including any TITLES:
REQUIRED FIELD
DAM :



Please enter the DAM REGISTRATION NUMBER.
DAM REG NO:


Thank you for entering this information.
Please select TOP OF PAGE and verify the information before you click on SUBMIT.

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