PRINT THIS OUT AND MAIL IT IN TO THE ADDRESS LISTED ON THE REGISTRATION
| Please fill out this form as complete as possible. If you are listing any dogs that are not registered with the ADSC or are out of the USA, please specify the owner/breeder of the first generation of dogs. If you are registering dogs with any titles or hip/elbow certifications please send proof of this. |
Owners Name:___________________________________________________________
Co-Owners Name (if any)__________________________________________________
Address:________________________________________________________________
City:_______________________ State: _______ Zip: _________
Phone: ( __)__________
Breed: Dutch Shepherd Variety:Short / Long / Rough Hair (circle one) Date of Birth:_________Sex:_____
Requests for single dog registration. How many?____ Litter ? How many?___?. Dog & Litter registration fee due when submitted to ADSC. Single dog $20.00. Litter $10.00 plus $5.00 per puppy registered.
| Print Dogs Name:_______________________________________________________ Owner of Sire:_____________________________________________________________ Owner of Dam:_____________________________________________________________ If the sire and dam of your dog are in the USA but not registered with the ADSC please submit their names anyway. If they are not X-rayed and certified they are not considered eligible for breeding, nor will the off spring of these dogs be eligible for registration. |
| Sire:_________________ Titles:________________ Hip/Elbow:____________ |
Grand
Sire:___________________ Titles:__________________ Hip/Elbow:______________ |
Great Grand Sire:____________________ Titles:___________________ Hip/Elbow:______________ |
| Great Grand Dam:__________________ Title:__________________ Hip/Elbow:_____________ |
||
| Grand
Dam:__________________ Titles:__________________ Hip/Elbow:______________ |
Great Grand Sire:__________________ Titles:_________________ Hip/Elbow:_____________ |
|
| Great Grand Dam:_________________ Titles:_________________ Hip/Elbow:_____________ |
||
| Dam:__________________ Titles:_________________ Hip/Elbow:_____________ |
Grand
Sire:___________________ Titles:__________________ Hip/Elbow:______________ |
Great Grand Sire:__________________ Titles:_________________ Hip/Elbows:____________ |
| Great Grand Dam:_________________ Titles:_________________ Hip/Elbows:____________ |
||
| Grand
Dam:__________________ Titles:__________________ Hip/Elbow:______________ |
Great Grand Sire:__________________ Titles:_________________ Hip/Elbows:____________ |
|
| Great Grand Dam:_________________ Titles:_________________ Hip/Elbows:____________ |
Owners Signature__________________________________________/Date:____________________
Co-Owners Signature:________________________________________/Date:____________________
Guardian:__________________________________________________/Date:____________________
*(if under 18 guardian must sign)
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CODE OF ETHICS
