APCA Breeder Registration Application

APCA Breeder Registration Application

Provide your details, breeding program information, and required documents for APCA review and approval.
Applicant Legal Name

First NameLast Name
Kennel/Breeding Program Name
Contact Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Website URL
Social Media Profiles (list handles or URLs)
Are you a current APCA member?
APCA Membership Number (if applicable)
Years of Breeding Experience
Describe your breeding experience
List all dogs currently owned (include registered names, breeds, and registration numbers)
Sire(s) Registration Information (registered name, registration number, registry)
Dam(s) Registration Information (registered name, registration number, registry)
Kennel Facilities and Location Description
Describe your breeding goals and practices
Describe your health testing and veterinary practices
Litter History (list previous litters, dates, and outcomes)
References (list at least two, include name, relationship, and contact information)
List any required permits or licenses held for breeding (if applicable)
Upload supporting documents (registrations, health certificates, permits, etc.)

Cancelof
Electronic Signature
Date of Submission

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
APCA Approval / Review Section (for APCA use only)
Breeder Number (assigned by APCA)
APCA Staff Reviewer Name
Review Notes / Comments
Approval Status
APCA Staff Signature
Review Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

APCA Breeder Registration Application

APCA Approval / Review Section (for APCA use only)