Date of Breeding_______/_______/______ | ![]() |
Date of Birth________/________/_______ |
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Breed______________________________ | Breed______________________________ | |
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Sire _______________________________ | Dam_______________________________ | |
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Reg.#______________________________ | Reg.#______________________________ | |
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Owner’s Signature__________________________ | Owner’s Signature__________________________ | |
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Address____________________________ | Address____________________________ | |
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City______________State_____Zip_____ | City______________State_____Zip_____ | |
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Phone_____________________________ | Phone_____________________________ | |
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IPDBA Kennel Name ________________ | IPDBA Kennel Number_______________ | |
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COLOR![]() |
COLOR![]() |
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1._____________________ _______ | 6._____________________ _______ | |
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2._____________________ _______ | 7._____________________ _______ | |
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3._____________________ _______ | 8._____________________ _______ | |
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4._____________________ _______ | 9._____________________ _______ | |
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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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