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
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