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EJRTCA Veterinarian Certificate
English Jack Russell Terrier Club Alliance, Inc.
An Official Club for the Short-Legged Jack Russell Terrier
531 Salem Cemetery Road Plain Dealing, LA 71064
Phone: (318) 286-7151 Email: jgccrawford@juno.com
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Terrier's Name: ___________________________________________________ Age: ____________
Owner's Name: ____________________________________________________________________
Address: _________________________________________________________________________
City: ________________________________________ State: _______ Postal Code: ____________
Phone Number: ___________________________ EJRTCA Membership # ____________________
1. Chest Measurement: ______ inches: (at deepest part of the chest behind front legs)
2. Height at point of withers: __________ inches.
3. Length of back: ________ inches (measured from base of tail to point of withers)
4. Coat: []Smooth []Rough []Broken
5. Teeth: []Scissors Bite []Level Bite []Undershot []Overshot []Other (describe)
_________________________________________________________________________________
6. Eyes: []Normal []No (describe) __________________________________________________
Vision: []Normal []No (describe) ___________________________________________________
Iris: []Brown []Blue []Yellow []Other ______________________________________________
CERF #: ____________________________
7. Hearing: []Normal []No (describe) ________________________________________________
BAER #: ____________________________
8. Cardiovascular: []Normal []No (describe) _________________________________________
9. Testicles: []Normal []No (describe) ______________________________________________
10. Hernia: []No []Umbilical []Iguinal []Other (describe) ______ _______________________
11. Legs: []Normal []Sub-luxating Patella []Luxating Patella, Grade _______ Other _______
(describe)________________________________________________________________________
12. Feet: (all four toes touching the ground?) []Normal []No (describe) _________________
13. Surgical Scars (describe): _______________________________________________________
14. Temperament (toward a non-threatening person): []Shy []Normal []Aggressive
15. Veterinarian's general opinion: Are there any reasons why this terrier cannot
function as a working dog or be used on the EJRTCA breeding program?
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Veterinarian's Signature: ____________________________________ Date: _________________
Address: _________________________________________________________________________
Phone: ___________________________________________________________________________
© English Jack Russell Terrier Club Alliance, Inc.
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