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Stud owner to fill out completely, print, sign, and mail to the EJRTCA..........
This is to certify the Bitch:
REGISTERED NAME: ________________________________________________________________
EJRTCA'S REGISTRATION NUMBER: _______________________
OWNED BY.....
NAME: ____________________________________________________________________________
ADDRESS: _________________________________________________________________________
CITY: _____________________________________________________________________________
STATE: _____________________ ZIP: _____________________ COUNTRY: ___________________
Was bred to my Stud Dog:
REGISTERED NAME: ________________________________________________________________
EJRTCA'S REGISTRATION NUMBER: _______________________
OWNED BY.....
NAME: ____________________________________________________________________________
ADDRESS: _________________________________________________________________________
CITY: _____________________________________________________________________________
STATE: _____________________ ZIP: _____________________ COUNTRY: ___________________
DATE(S) BRED:
__________________________________________________________________________________
Are either the Sire or Dam Registered with any other organizations? If so, please give name
of organization and registration number:
__________________________________________________________________________________
As the owner(s) of the Stud, I (we) hereby certify this information to be true.
Signed: ____________________________________________________ Date: _________________
Signed: ____________________________________________________ Date: _________________
Form ej-stud.html Issued 4/8/97 updated 9/8/99, 7/6/05, 1/1/07
© English Jack Russell Terrier Club Alliance, Inc.
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