IWC Litter Registration Application

Date

Must use mm-dd-yyyy format, or use calendar icon to choose

Breeder*

Co-Breeder (if any)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Country

Best Phone Number*

Area CodePhone Number

Email*

example@example.com

Sire's Registered Name

Sire's Registration Number

Sire's Embark Swab Number

(if known)

Sire's DNA Profile # if from a different laboratory than Embark.)

(If known)

Dam's Registered Name

Dam's Registration Number

Dam's Embark Swab Number

(if known)

Dam's DNA Profile # if from a different laboratory than Embark.)

(If known)

Litter Birthdate*

Date

Number Puppies in Litter*

Please send copies of MDR1 & CEA Lab Reports on all puppies.*
*If BOTH parents are N/N (+/+ or A) for MDR1 and/or CEA, send the PARENTS lab reports IF they are not already on file with the Registrar.
Please send DNA Proof of Parentage for the litter.
If one or both parents are smooth coated Windsprites, send copies of the FGF5 coat length test results for each puppy.

Send all lab reports and any questions to Treasurer4IWC@gmail.com

Fees:

Litter Registration & Registration Certificates: $20 + $5 per puppy

Certified Pedigress: add $5 per puppy

International (outside of USA) please add $6 for postage for each international address documents will be mailed to.

PAYMENT*

Payment vis PayPal. Send to Treasurer4IWC@gmail.comPayment via Venmo. Send to @International-WindspriteClubMail check or money order payable to "IWC" in US$. Send to IWC c/o 33 Pine Grove Rd, Nottingham PA 19362

TOTAL PAYMENT DUE $

When form is complete, scroll to very end of form and click on the red SUBMIT button.

Puppy Information

When you have completed information on all puppies, scroll to the very end of the form for button to submit application. Don't forget to pay the registration fee as indicated above (PayPal, Venmo, or check).

(There is space on the form for 10 puppies. If you have more than 10, please contact registrar at Treasurer4IWC@gmail.com.)

Puppy # 1

#1 Registered Name

#1 Call Name

#1 Puppy Name or ID

(The name that could be on DNA parentage, MDR1, FGF5, CEA, etc results.)

#1 Variety

LonghairSmooth

#1 Sex*

MaleFemale

#1 Color*

#1 Markings

#1 Microchip Number

(if any)

#1 Embark SWAB # (if Embark tested)

#1 DN Profile Number (if tested at another laboratory.)

#1 Genetic COI per Embark (or other lab)

#1 MDR1

N/N (+/+) (A) (Normal)N/M (+/-) (B) (Carrier)M/M (-/-) (C) (Affected)

#1 CEA

N/N (+/+) (A) (Normal)N/M (+/-) (B) (Carrier)M/M (-/-) (C) (Affected)

#1 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#1 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#1 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#1 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#1 Owner

#1 Co-Owners (if any)

#1 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#1 Owner Email

example@example.com

#1 Owner Phone Number

Area CodePhone Number

Puppy # 2

#2 Registered Name

#2 Call Name

#2 Puppy Name or ID

#2 Variety

LonghairSmooth

#2 Gender

MaleFemale

#2 Color

#2 Markings

#2 Microchip Number

(if any)

#2 Embark SWAB # (if Embark tested)

#2 DN Profile Number (if tested at another laboratory.)

#2 Genetic COI per Embark (or other lab)

#2 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#2 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#2 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#2 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#2 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#2 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#2 Owner

#2 Co-Owner(s) if any

#2 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#2 Owner Email

example@example.com

#2 Owner Phone Number

Area CodePhone Number

Puppy # 3

#3 Registered Name

#3 Call Name

#3 Puppy Name or ID

#3 Variety

LonghairSmooth

#3 Gender

MaleFemale

#3 Color

#3 Markings

#3 Microchip Number

(if any)

#3 Embark SWAB Number (if Embark tested)

#3 DN Profile Number (if tested at another laboratory.)

#3 Genetic COI per Embark (or other lab)

#3 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#3 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#3 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#3 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#3 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#3 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#3 Owner

#3 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#3 Co-Owner(s) if any

#3 Owner Email

example@example.com

#3 Owner Phone Number

Area CodePhone Number

Puppy # 4

#4 Registered Name

#4 Call Name

#4 Puppy Name or ID

#4 Variety

LonghairSmooth

#4 Gender

MaleFemale

#4 Color

#4 Markings

#4 Microchip Number

(if any)

#4 Embark SWAB Number (if Embark tested)

#4 DN Profile Number (if tested at another laboratory.)

if known

#4 Genetic COI per Embark (or other lab)

#4 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#4 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#4 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#4 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#4 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#4 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#4 Owner

#4 Co-Owner(s) if any

#4 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#4 Owner Email

example@example.com

#4 Owner Phone Number

Area CodePhone Number

Puppy # 5

#5 Registered Name

#5 Call Name

#5 Puppy Name or ID

#5 Variety

LonghairSmooth

#5 Gender

MaleFemale

#5 Color

#5 Markings

#5 Microchip Number

(if any)

#5 Embark SWAB Number (if Embark tested)

#5 DN Profile Number (if tested at another laboratory.)

if known

#5 Genetic COI per Embark (or other lab)

#5 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#5 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#5 FGF5 Coat Length(must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#5 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#5 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#5 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#5 Owner

#5 Co-Owner(s) if any

#5 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#5 Owner Email

example@example.com

#5 Owner Phone Number

Area CodePhone Number

Puppy # 6

#6 Registered Name

#6 Call Name

#6 Puppy Name or ID

#6 Variety

LonghairSmooth

#6 Gender

MaleFemale

#6 Color

#6 Markings

#6 Microchip Number

(if any)

#6 Embark SWAB Number (if Embark tested)

#6 DN Profile Number (if tested at another laboratory.)

if known

#6 Genetic COI per Embark (or other lab)

#6 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#6 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#6 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#6 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#6 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#6 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#6 Owner

#6 Co-Owner(s) if any

#6 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#6 Owner Email

example@example.com

#6 Owner Phone Number

Area CodePhone Number

Puppy # 7

#7 Registered Name

#7 Call Name

#7 Puppy Name or ID

#7 Variety

LonghairSmooth

#7 Gender

MaleFemale

#7 Color

#7 Markings

#7 Microchip Number

(if any)

#7 Embark SWAB Number (if Embark tested)

#7 DN Profile Number (if tested at another laboratory.)

if known

#7 Genetic COI per Embark (or other lab)

#7 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#7 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#7 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#7 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#7 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#7 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#7 Owner(s)

#7 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#7 Owner Email

example@example.com

#7 Owner Phone Number

Area CodePhone Number

Puppy # 8

#8 Registered Name

#8 Call Name

#8 Puppy Name or ID

#8 Variety

LonghairSmooth

#8 Gender

MaleFemale

#8 Color

#8 Markings

#8 Microchip Number

(if any)

#8 Embark SWAB Number (if Embark tested)

#8 DN Profile Number (if tested at another laboratory.)

if known

#8 Genetic COI per Embark (or other lab)

#8 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#8 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#8 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#8 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#8 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#8 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#8 Owner(s)

#8 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#8 Owner Email

example@example.com

#8 Owner Phone Number

Area CodePhone Number

Puppy # 9

#9 Registered Name

#9 Call Name

#9 Puppy Name or ID

#9 Variety

LonghairSmooth

#9 Gender

MaleFemale

#9 Color

#9 Markings

#9 Microchip Number

(if any)

#9 Embark SWAB Number (if Embark tested)

#9 DN Profile Number (if tested at another laboratory.)

if known

#9 Genetic COI per Embark (or other lab)

#9 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#9 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#9 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#9 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#9 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#9 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#9 Owner(s)

#9 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#9 Owner Email

example@example.com

#9 Owner Phone Number

Area CodePhone Number

Puppy # 10

#10 Registered Name

#10 Call Name

#10 Puppy Name or ID

#10 Variety

LonghairSmooth

#10 Gender

MaleFemale

#10 Color

#10 Markings

#10 Microchip Number

(if any)

#10 Embark SWAB Number (if Embark tested)

#10 DN Profile Number (if tested at another laboratory.)

if known

#10 Genetic COI per Embark (or other lab)

#10 MDR1

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#10 CEA

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)

#10 FGF5 Coat Length (must be submitted if either parent is a smooth Windsprite)

N/N (+/+) (A)N/M (+/-) (B)M/M (-/-) (C)N/A

#10 Copper Toxicosis ATP7A (attenuating)

ClearOne CopyTwo copies

#10 Copper Toxicosis ATP7B (accumulating)

ClearOne CopyTwo copies

#10 Copper Toxicosis RETN (attenuating)

ClearOne CopyTwo copies

#10 Owner(s)

#10 Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

#10 Owner Email

example@example.com

#10 Owner Phone Number

Area CodePhone Number

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