Individual Dog Registration Form

ONLY GERMAN SHEPHERD dogs may be registered. A copy of the dog's registration from any FCI Member Kennel Club MUST accompany this application for USCA registration. Copies of USCA recognized working titles, show ratings, breed surveys and hip ratings not already on file with the USCA Office must be submitted with this application or they will not appear on the USCA Registration.

"*" indicates required fields

Dog's Name*

Gender*

Male

Female

Dog's Date of Birth*

Date of Purchase

Country of Birth

Recognized Working Titles

OFA# and rating or “a” Stamp rating

Breed Survey

Show Rating

AKC Registration #

SV Registration #

Other Registration #

Type of Coat

Colors and Markings

Name of Breeder

Sire Information

Name of Sire

USA Reg. #

AKC Reg. #

SV Reg. #

Other Reg. #

Recognized Working Titles

Breed Survey

Show Rating

OFA# and rating or “a” Stamp rating

Dam Information

Name of Dam

USA Reg. #

AKC Reg. #

SV Reg. #

Other Reg. #

Recognized Working Titles

Breed Survey

Show Rating

OFA# and rating or “a” Stamp rating

Owner Information

First Name*

Last Name*

Street Address*

Address 2

City*

State*

Zip Code*

Country*

Member ID*

Co-Owner

Home Phone*

Identification

I certify that I have examined the tattoo of this dog.

Tattoo

All dogs registered with USA are required to have positive identification. If the dog is tattooed prior to registration with USA, the tattoo MUST be verified by a USA Tattooer, USA Breed Warden, Licensed Veterinarian, Member of the USA Breed Advisory Committee or Körmeister. Verification of the identification must be submitted to the USA Office before the pedigree will be issued.

Location of Tattoo

RE-Right Ear

LE-Left Ear

IRT-Inner Right Thigh

ILT-Inner Left Thigh

A - Abdomen

Tattoo / Chip Number

Payment

Individual Dog Registration Fee*

$35

Total Amount:

Price: $0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Authenticity*

I certify that all information on this application is true and correct and that I am the Owner/Co-Owner of the dog on this application.

I understand that any misrepresentation on this application is cause for revocation of the USA dog registration and may result in the loss of all USA privileges which could include expulsion from USA.

I certify that all information on this application is true and correct and that I am the Owner/Co-Owner of the dog on this application. I understand that any misrepresentation on this application is cause for revocation of the USA dog registration and may result in the loss of all USA privileges which could include expulsion from USA.

USCA Individual Dog Registration Application

Individual Dog Registration Form

￼￼Sire Information

Dam Information

￼￼Owner Information

￼￼Identification

Payment

Sire Information

Owner Information

Identification