Litter Nomination Form |
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| Date of Whelping: Month_____ Day _____ Year _____ |
Date of this nomination: Month ____ Day ___ Year ___ |
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Number of Puppies _____ |
| Sire:_____________________________________________AKC #:______________________ |
| Dam:____________________________________________AKC # :_____________________ |
| Breeders name: _________________________________________ Breeders address: ________________________________________ |
| City: ________________________________________ State: ______ Zip: ____________ |
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I enclose $ ____________ for the litter nomination in Region _____________________ |
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SEND FORMS TO: Name: _____________________________________ Address: __________________________________________________ |
| City: _______________________________ State: ____ Zip: ___________ |
| Quantity: ________ Signed: ______________________________________ Tel.
No.: _________________________ |
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Juvenile Litter Questionaire
Litter # ___________ |
| Sire:_______________________________ AKC #:________________OFA Cert. __ Yes __ No |
| Dam:______________________________AKC # :________________OFA Cert. __ Yes __ No |
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TOTAL NUMBER OF PUPS ________ Males: _______Females:_______ |
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Still born: Male: ____ Female: ____ Died within 3 weeks: Male:____ Female: ____ |
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Color code: |
Black = B; |
Sable = S; |
Black & Tan = B/T; |
B1 color = B1C; |
Blue = Blue; |
Brown = LV |
Males: 1____ 2____3____ 4 ____ 5 ____ 6____ 7____ 8____ |
Females: 1____ 2____3____ 4 ____ 5 ____ 6____ 7____
8____ |
| LITTER
CHARACTERISTICS (leave blank unless applicable) |
HEALTH CHARACTERISTICS | ||||
| Long Coats | M__ F__ | Fading Puppies | M__ F__ | Heart: (ask vet for diagnosis) | |
| Monorchid | M__ F__ | Cryptorchid Males | M__ F__ | Murmur | M__ F__ |
| Umbilical Hernias |
M__ F__ | Cleft Palates | M__ F__ | PDA | M__ F__ |
| Dwarfism | M__ F__ | Carpal Syndrome Pasterns |
M__ F__ | PRAA | M__ F__ |
| Undershot Bite | M__ F__ | Overshot Bite | M__ F__ | SAS | M__ F__ |
| Level Bite | M__ F__ | Wry (twisted) Bite | M__ F__ |
OTHER: (Please Specify)___________ _____________________________ |
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| Ankylosis | M__ F__ | Seizures | M__ F__ | Band around esophagus due to PRAA | M__ F__ |
| ESOPHAGEL:
(Ask vet for diagnosis -- See BLUE BOOK II for articles) Dilation or "Ballooning" of the esophagus |
M__ F__ | ||||
List three outstanding qualities of this litter:
1._________________________ 2._________________________ 3._________________________
Particular Problems (Structure, Gait, Temperament):______________________________________
Futurity Regional Areas
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REGION # 1 NORTHEASTERN - Maine, Vermont, Massachusetts, New Hampshire, New York, Rhode Island, Connecticut - |
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REGION # 2 MID-ATLANTIC -New Jersey, Delaware, West Virginia, Pennsylvania, Maryland, Virginia. - |
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REGION # 3 SOUTHEASTERN - North Carolina, Tennessee, Mississppi, Georgia, South Carolina, Louisiana, Alabama, Florida, Puerto Rico - |
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REGION # 4 GREAT LAKES - Michigan, Ohio, Indiana, Kentucky - |
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REGION # 5 MIDWESTERN - Wisconsin, Missouri, Illinois, Iowa, Mnnesota - |
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REGION # 6 SOUTHWESTERN - Texas, Oklahoma, Nebraska, Arkansas, Kansas, Colorado, New Mexico - |
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REGION # 7 SOUTHERN PACIFIC - Arizona, Las Vegas, Nevada, *Southern California (all counties south of San Luis Obispo; Kern & San Bernardino)- |
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REGION # 8 MID-PACIFIC Nevada(Except Las Vegas), Utah, Northern California (all counties north of San Luis Obispo; Kern & San Bernardino) - |
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REGION # 9 NORTHWESTERN - Washington, Idaho, Wyoming, South Dakota, Oregon, Montana, North Dakota, Alaska, all of Canada - |
Mail form to: Jim Rau Dog Shows, LTD., |
updated 1/30/2008