Wild Rose English Springer Spaniel Association of Alberta

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:




Name of Sire:


Name of Dam:










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.