Date of Breeding_______/_______/______ | Date of Birth________/________/_______ | |
Breed______________________________ | Breed______________________________ | |
Sire _______________________________ | Dam_______________________________ | |
Reg.#______________________________ | Reg.#______________________________ | |
Owner’s Signature__________________________ | Owner’s Signature__________________________ | |
Address____________________________ | Address____________________________ | |
City______________State_____Zip_____ | City______________State_____Zip_____ | |
Phone_____________________________ | Phone_____________________________ | |
IPDBA Kennel Name ________________ | IPDBA Kennel Number_______________ | |
COLORSEX | COLORSEX | |
1._____________________ _______ | 6._____________________ _______ | |
2._____________________ _______ | 7._____________________ _______ | |
3._____________________ _______ | 8._____________________ _______ | |
4._____________________ _______ | 9._____________________ _______ | |
5._____________________ _______ | 10.____________________ _______ |
Submit this form completed with $15.00 to the registry office below. The owner of the dam will receive a blue puppy registration for each puppy in the litter. Blue puppy papers must be kept or transferred and later submitted for permanent registration. |
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P.O. Box 311 Upton, KY 42784 Phone: (270) 531- 3662 Email: ipdbaregistry@gmail.com |
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