A natural breeding
BREED______This litter is a result of: Circle one
Artificial insemination
DATE OF BIRTH __ __ /__ __ /__ __ PLACE OF BIRTH______
Month Day Year Country
NUMBER OF LIVING DOGS ON THIS DATE: ______
Males Females
SIRE'S NAME & NCA REG. #______
If sire is not registered with the NCA, please furnish a copy of sire's registration form from NCA recognized registry and check here _____
DAM'S NAME & NCA REG. #______
If dam is not registered with the NCA, please furnish a copy of dam's registration form from NCA recognized registry and check here _____
OWNER OF SIRE ON DATE OF MATING______
NCA PIN
DATE OF MATING __ __ / __ __ / __ __ PLACE OF MATING______
Month Day Year Country
I certify that the above named sire was mated to the above dam and that the sire was owned by me on the date of mating.
OWNER OF SIRE'S SIGNATURE______
OWNER OF DAM ON DATE OF BIRTH______
NCA PIN
OWNER'S ADDRESS______
Street City State Zip Code
OWNER'S PHONE NUMBER ( ) - E-MAIL______
I certify that I am the owner of the above named dam on the date of birth of the litter and that this dam was not mated to any other dog during her season. I apply to register this litter and further certify that all information on this application is true. I agree to comply with NCA rules and regulations.
OWNER OF DAM'S SIGNATURE______DATE______
Instructions For Completing NCA's Purebred Litter Registration Application
1. Please type or print clearly ALL INFORMATION (except signatures). Any illegible applications will be rejected if we cannot read all information requested.
2. Any misrepresentation on this application is a cause for cancellation and may result in loss of all NCA privileges.
3. Sire and Dam must be registered with the NCA or registered by an NCA recognized registry (see Appendix A in NCA's Rules and Regulations for Canine Registrations and Performance Events). Sire and Dam must be recorded in the ownership of the persons who were the actual owners on the dates of mating and birth before this application is submitted.
4. Litters eligible for registration with the NCA must be registered in ONE name only. In the event the litter is owned by more than one individual, or is registered with another registry, contracts and breeding agreements may be made between co-owners. The fact that only one name is listed as the registered litter owner with the NCA will in no way affect these other agreements. However, in all dealings with the NCA, only the individual listed as the NCA registered litter owner will be recognized in all transactions with the NCA. It is advisable to inform the new puppy owners of the NCA rule which requires that a dog MUST be registered in ONE name only.
5. Failure to sign and date this application along with incorrect fee will result in delay of processing registration application.
6. If this application is accepted, NCA will send the litter owner one individual registration certificate for each dog in the litter. These individual registration certificates should be furnished AT THE TIME ownership of the puppy is transferred.
7. If you have any questions regarding this registration application, please contact the NCA by mail addressed to 5 Wagon Wheel Way Ocala, FL 34482 or send an e-mail message to .
8. This form may be reproduced.