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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: __________________________________________________________________________ Address: ________________________________________________________________________ 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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