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I hereby present the following terrier for EJRTCA registration:
TERRIER'S NAME: ____________________________________________________
BORN: ________________________ SEX: []Male []Female []Spayed/Neutered
HEIGHT: ___________inches. (measure from floor to top of withers)
COAT: []Smooth []Broken []Rough
COAT COLOR: []White/Brown []White/Black []Tri color []Other: ___________
EJRTCA Litter Registration Number: ____________________________________
Information on the Sire:
Name: ____________________________________ EJRTCA Reg. # ____________
Height: __________ inches at withers, Coat []Smooth []Broken []Rough
Coat Color: []White/Brown []White/Black []Tri color []Other:_________________
Owner: _________________________________________________________________
Address: ________________________________________________________________
City: _________________________State: ______ Zip: _______ Phone: _____________
Information on the Dam:
Name: _____________________________________EJRTCA Reg. # ________________
Height: __________ inches at withers, Coat []Smooth []Broken []Rough
Coat Color: []White/Brown []White/Black []Tri color []Other: _________________
Owner: _________________________________________________________________
Addres _________________________________________________________________
City: _________________________ State: ______ Zip: ________Phone: ___________
Terrier owned by...
Name: _________________________________________________________________
Address: _______________________________________________________________
City: ___________________________ State: ______ Zip: _______Country:__________
Home Phone: _____________________________ EJRTCA Member #: ____________
Email: __________________________________________________________________
Owner's Signature: ____________________________________ Date: ____________
© English Jack Russell Terrier Club Alliance, Inc.
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