Your Name:

Address: House Name/Number Street Village County Post Code

Telephone:   E Mail:

Your Kennel Name / Affix:

Date of Birth: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Registration No:     

Name of Dog :

Colour: White Red Chocolate Silver Patch Ink Mark Sable Grey Black Cream            Eye Colour: Amber Brown Green Grey Hazel Wall Yellow Odd    Status: Proven Un-Proven

Hip score: 0 Not Done 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 A B C D E 0 Not Done 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 A B C D E   Eye Test Result

Microchip No               DNA Profile  

Other test results: (Please specify)

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Face Shot

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Hip Score 

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