Previous Litter Number from the same cross if known___________________

Sire's Registered Name________________________________AHTCA Reg #________________

Owned By:_________________________________________________Member #____________
                                                                                                                   (if available)
Address:______________________________________________________________________

City_______________________________________________State________Zip_____________

Dam's Reg Name___________________________________AHTCA Reg #__________________

Owned By:_________________________________________________Member #____________
                                                                                                                   (if available)
Address_______________________________________________________________________

City______________________________________________State________Zip______________

Date(s) bred____________________________________________________________________

Date Whelped_______________________________________Number Born_________________

Males: Black/Tan_____Black/Red_____Solid Tan_____Solid Red_____More than*10%White_____

Females: Black/Tan____Black/Red_____Solid Tan____Solid Red_____More than*10%White_____

*More than 10% white would also include white appearing in places other than chest or toes.
Please enclose $15.00 for a litter of 3 or more, $5.00 for one pup and $10.00 for 2 pups.

Are either the Sire or Dam Registered with any other clubs?
If so please give the name of the organization and the registration number.
Sire:__________________________________________________________________________

Dam:_________________________________________________________________________

As the owners of the Dam, I hereby certify this information to be true and correct.

Signed____________________________________________________Date________________

Signed____________________________________________________Date_________________
    
                                    
Home of the black and tan Jack Russell
Application for AHTCA Litter Registration
American Hunt Terrier Club Association, INC
13288 Bean Rd  Alexander, AR  72002
%Karen Adams
Phone: 501-607-4455   Email: ahtcalady@gmail.com
Use your browsers print button, fill out completely and
mail to the AHTCA