Litter Application Form - American Dog Breeders Association printable pdf download

For office use only

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LITTER REGISTRATION

AMERICAN DOG BREEDERS ASSOCIATION INC.

P.O. BOX 1771 - SALT LAKE CITY, UT. 84110 - (801) 936-7513 -

● Before the litter can be registered both Sire and Dam must be ADBA registered, have a registered name on file and have ownership recorded in the current

owner’s name. ●If the required information is not listed on the front of parents registration certificate, a Transfer of Ownership is needed or dogs registered

name needs to be recorded with the ADBA registration office. ●If Sire, Dam or both are not registered with the ADBA, you must apply for registration with a

Single Registration Application. Paperwork (of Sire, Dam or both) must be processed before the litter can be processed. Completed registrations will then be

sent to appropriate owner(s). If paperwork is to be sent to a third party, written permission must be given. ● Be sure to list all pups, pups not listed on this form

will be considered dead. ● Pups over one year of age cannot be registered as a litter. They must be registered on a single registration application. ● If Sire or

Dam is less than 9 months at time litter is born or over 12yrs at time of breeding, DNA profile of parent and 1 pup is required. ●Be sure to mail all forms

together to speed up registration process. ● Photo of Dam with litter, required for registration.

Breed _____________________________________________

___ / ___ /____

Date of Birth of Litter

No. in litter_________________ No. Males__________________ No. Females_______________

Day

Year

Month

Only live pups are to be registered, pups not listed on litter application will be considered dead.

Owner of Litter

*If owner of litter is not owner of Dam, owner of Dam must sign above*

Signature of owner of litter____________________________________________________________________

Address___________________________________________________________________________________

City___________________________________________ State_____________________ Zip ______________

Phone (______)__________________________________E-mail_______________________________________

(For Paperwork Status And Canine Legislation Alerts)

THE SIRE OF LITTER

THE DAM OF LITTER

Name of Sire__________________________________________________

Name of Dam _________________________________________________

Registration #_________________________________________________

Registration # _________________________________________________

Sire is owned by_______________________________________________

Dam is owned by_______________________________________________

Address______________________________________________________

Address ______________________________________________________

City_______________________ State____________ Zip______________

City_______________________ State____________ Zip_______________

This breeding was the result of

Artificial Insemination

Owner of Dam (please check one)

□ Natural breeding

□ I witnessed this breeding.

□ I did not witness this breeding.

□

Direct collection and insemination

□ Artificial Insemination

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Cooled Semen

Photo of Dam with litter, required for registration.

□

Frozen Semen

See policies on using cooled or frozen semen and attach required form AIFS or FRCS

Signature of person doing Breeding________________________________

In response to Anti-Canine Legislation, the ADBA Pledges $1.00 per pup to organizations involved in the struggle to preserve owners and breeders rights.

Litter Fee Under the age of six months

$10.00Application fee + $3.00 per pup

Total Due $

Litter Fee Over the age of six months

$20.00 Application fee + $4.00 per pup

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Breeders Copy of Four Generation Pedigree of Litter

Additional Fee $15.00

Breeders Copy of Six Generation Pedigree of Litter

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Additional Fee $25.00

Breeders copy of Seven Generation Pedigree of Litter

Additional Fee $45.00

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Rush - 10 Working Day Service (per application Form)(Nonrefundable)

Additional Fee $10.00

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Super Rush - 2 Working Day Service (per application Form)(Nonrefundable) please indicate super rush on envelope

Additional Fee $25.00

All Super Rush paperwork fees must be paid with credit card or money order

Tube mailing of Pedigrees.

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Additional Fee $10.00

Classified Ad on ADBA Website for 30 Days Includes basic info about litter. Will you ship at buyer’s expense? Y / N Price for Pups

Additional Fee $ 5.00

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$________

One year subscription for APBT Gazette (one year Overseas subscription for APBT Gazette $75.00)

Additional Fee $35.00

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Overseas Mailing

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Additional Fee $10.00

CREDIT CARD #

EXPIRES

Security Code

Total

Applications Sent on Request

□ Litter Application

□ Single Application

□ Other ____________________

BREEDER If breeders name is to be placed in front of pups name, format is limited to breeders first or last name, or breeders name initials. Any other variation must be registered

as an ADBA kennel name (See kennel app for details). (No exceptions). Name your puppies carefully. It is the policy of the ADBA that the registered name of a dog remains

Breeders Name_______________________________

permanent, unless breeder’s permission is given for change and the dog has never been bred.

If you prefer that the new owner name the puppy, assign each an alphabetical letter.

Name (Limit 25 character-spaces and punctuation count)

Sex

Color (Color chart on reverse side and on website)

10.

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Litters in excess of 10 (check box) list on back side/second page

SERVICE CERTIFICATE

I verify that my male (Name of Male) ______________________________________ADBA Reg. #_____________________

was bred to this female (Name of Female) __________________________________ ADBA Reg. #_____________________on