The owner(s) of the dam at time of breeding may designate another person(s) to be the breeder of a specified litter.


Recorded owner of the dam at time of Breeding:________________________________________________

Dam Name:_________________________________________________Reg No._____________________

Litters date of birth:__________________________________________

I hereby assign the designation of breeder, to the person(s) listed below for the litter described. I understand that
person(s) to whom I am assigning the designation of breeder will be treated in all respects as the breeder(s) of this
litter and will be shown as such on the Litter Registration.

Signature of recorded owner(s) of dam at time of breeding.

_____________________________________________________________________Date:______________



Breeder designation to be assigned to:

Member Number: ____________ if known

Name:____________________________________________________

Address:__________________________________________________

City:______________________________________________________State_________Zip:______________

Telephone:_____________________________email:_____________________________________________





           
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The only Association set out to promote, preserve and keep a registry of the "original" black and tan Jack Russell Terrier (Hunt Terrier).