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

City State / Province

Postal / Zip Code

Country

Best Phone Number *

Area Code Phone Number

Email *

example@example.com

Sire's Registered Name

Sire's Registration Number

Sire's DN Number

(If known)

Sire's Embark Swab Number

(if known)

Dam's Registered Name

Dam's Registration Number

Dam's DN Number

(If known)

Dam's Embark Swab Number

(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 unless already on file with Registrar.
If one or both parents are smooth coated Windsprites, send copies of the FGF5 coat length test results.

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 $5 for postage

PAYMENT *

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

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, or CEA results.)

#1 Variety

Longhair Smooth

#1 Gender *

Male Female

#1 Color

#1 Markings

#1 DN Number

#1 Embark Swab Number

#1 Microchip Number

(if any)

#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 Owner

#1 Co-Owners (if any)

#1 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#1 Owner Phone Number

Area Code Phone Number

#1 Owner Email

example@example.com

Puppy # 2

#2 Registered Name

#2 Call Name

#2 Puppy Name or ID

#2 Variety

Longhair Smooth

#2 Gender

Male Female

#2 Color

#2 Markings

#2 DN Number

#2 Embark Swab Number

#2 Microchip Number

(if any)

#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 Owner

#2 Co-Owner(s) if any

#2 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#2 Owner Phone Number

Area Code Phone Number

#2 Owner Email

example@example.com

Puppy # 3

#3 Registered Name

#3 Call Name

#3 Puppy Name or ID

#3 Variety

Longhair Smooth

#3 Gender

Male Female

#3 Color

#3 Markings

#3 DN Number

#3 Embark Swab Number

#3 Microchip Number

(if any)

#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 Owner

#3 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#3 Co-Owner(s) if any

#3 Owner Phone Number

Area Code Phone Number

#3 Owner Email

example@example.com

Puppy # 4

#4 Registered Name

#4 Call Name

#4 Puppy Name or ID

#4 Variety

Longhair Smooth

#4 Gender

Male Female

#4 Color

#4 Markings

#4 DN Number

#4 Embark Swab Number

#4 Microchip Number

(if any)

#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 Owner

#4 Co-Owner(s) if any

#4 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#4 Owner Phone Number

Area Code Phone Number

#4 Owner Email

example@example.com

Puppy # 5

#5 Registered Name

#5 Call Name

#5 Puppy Name or ID

#5 Variety

Longhair Smooth

#5 Gender

Male Female

#5 Color

#5 Markings

#5 DN Number

#5 Embark Swab Number

#5 Microchip Number

(if any)

#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 Owner

#5 Co-Owner(s) if any

#5 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#5 Owner Phone Number

Area Code Phone Number

#5 Owner Email

example@example.com

Puppy # 6

#6 Registered Name

#6 Call Name

#6 Puppy Name or ID

#6 Variety

Longhair Smooth

#6 Gender

Male Female

#6 Color

#6 Markings

#6 DN Number

#6 Embark Swab Number

#6 Microchip Number

(if any)

#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 Owner

#6 Co-Owner(s) if any

#6 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#6 Owner Phone Number

Area Code Phone Number

#6 Owner Email

example@example.com

Puppy # 7

#7 Registered Name

#7 Call Name

#7 Puppy Name or ID

#7 Variety

Longhair Smooth

#7 Gender

Male Female

#7 Color

#7 Markings

#7 DN Number

#7 Microchip Number

(if any)

#7 Embark Swab Number

#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 Owner(s)

#7 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#7 Owner Phone Number

Area Code Phone Number

#7 Owner Email

example@example.com

Puppy # 8

#8 Registered Name

#8 Call Name

#8 Puppy Name or ID

#8 Variety

Longhair Smooth

#8 Gender

Male Female

#8 Color

#8 Markings

#8 DN Number

#8 Embark Swab Number

#8 Microchip Number

(if any)

#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 Owner(s)

#8 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#8 Owner Phone Number

Area Code Phone Number

#8 Owner Email

example@example.com

Puppy # 9

#9 Registered Name

#9 Call Name

#9 Puppy Name or ID

#9 Variety

Longhair Smooth

#9 Gender

Male Female

#9 Color

#9 Markings

#9 DN Number

#9 Embark Swab Number

#9 Microchip Number

(if any)

#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 Owner(s)

#9 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#9 Owner Phone Number

Area Code Phone Number

#9 Owner Email

example@example.com

Puppy # 10

#10 Registered Name

#10 Call Name

#10 Puppy Name or ID

#10 Variety

Longhair Smooth

#10 Gender

Male Female

#10 Color

#10 Markings

#10 DN Number

#10 Embark Swab Number

#10 Microchip Number

(if any)

#10

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

#10

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

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

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

#10 Owner(s)

#10 Owner Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

#10 Owner Phone Number

Area Code Phone Number

#10 Owner Email

example@example.com

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