Single Wachtelhund Registration

Owner Information:

Print Name(S) of Registrants(s): ______________________________ / _________________________________

(No more than two Registrants)

Mailing Address:  ____________________________________________________________________________

City: __________________________________________________ State: ____________ ZIP: ______________

Day Phone ( ______ ) _______________________  Cell Phone ( _______ ) ____________________________

E-mail Address: ______________________________________________________

Print Name(S) of Registrant(s): _____________________________ / __________________________________

Signature(s): ____________________________________________ / __________________________________

Dog Information:

Dog Name: _______________________________________ UKC# ______________ VDW# ________________

Date of Birth: _______________________________________________

Breeders Name: ____________________________ Kennel Name: ____________________________________

City: __________________________________________________State: __________ ZIP _____________

Sire Name: _____________________________________ UKC# ______________ VDW# ________________

Dam Name: _____________________________________ UKC# _____________ VDW# ________________

Please attach a copy of any pedigree, VDW or UKC, or any information that verifies the dog is a purebred Wachtelhund