Wild Rose English Springer Spaniel Association of Alberta
SPRINGER REGISTRY

Section A is required Information. We hope that you will also complete Sections B & C to help provide a complete Registry.

A: Identification Section

Registered Name (of Dog):

Call Name:

Registration Number:

Tatoo/Microchip/Nose Print Number:

Date of Birth:

Date of Death:

Breeder:

Name of Sire:

Name of Dam:

Colour:

Height:

Weight:

Owner(s)

Please provide pedigree on the back of this form or attach separately.

B: Health Section

Eye Certification (i.e. ACVO, CERF etc.) & Date

Hip Certification (i.e. OFA, OVC) & Rating

Other Health Accreditations (i.e. vWD, PFK, etc.)

Spayed or Neutered (& date)

Available for Breeding?

Number of Litters

Average Size of Litters

Temperament Certification (i.e. TT, CGC etc.)

C: Title Section

Please provide Title, Registry (i.e. CKC; AKC; UKC) & Date Received

Conformation Titles

Obedience Titles

Agility Titles

Tracking Titles

Hunting Titles

Scent Hurdling Titles

Other Title (please specify)

Please feel free to add any other comments or information as desired on the back or attach to the form.