TERRIER'S Reg NAME: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
(limited to 28 characters and spaces)
Pet Name:_______________________
BORN: ________________________ (must be 8 months of age)
SEX:  [ ]Male   [ ]Female   [ ]Spayed/Neutered
HEIGHT: ___________inches. (measure from floor to top of withers)
COAT:   [ ]Smooth   [ ]Broken   [ ]Rough   
COAT COLOR:      [ ]Black/Brown   [ ]Black/Red [ ]Lemon tan   [ ]Red [ ]More than 10% white
AHTCA Litter Registration Number: _________________________________________________

Information on the Sire:
If you are using a stud other than your own, please fill out the stud service form.
Name: __________________________________________ AHTCA Reg. # ___________________
Height: __________ inches at withers,   Coat    [ ]Smooth   [ ]Broken   [ ]Rough
Coat Color:   [ ]Black/Tan   [ ]Black/Red [ ]Lemon Tan   [ ]Red   

Owner: __________________________________________________________________________
Address: ________________________________________________________________________
City: ___________________________ State: ______ Zip: ___________ Phone: _______________

Information on the Dam:
Name: __________________________________________ AHTCA Reg. # ___________________
Height: __________ inches at withers,   Coat    [ ]Smooth   [ ]Broken   [ ]Rough
Coat Color:   []Black/Tan  [ ]Black/Red [ ]Lemon Tan   [ ] Red   

Owner: __________________________________________________________________________
Address: ________________________________________________________________________
City: _________________________ State: ______  Zip: ___________  Phone: ________________
Enclose 1.) 3 pictures front, and sides along 2.) Original litter registration 3.)  $15.00 registration fee.

Hunt Terrier owned by...
Name: ___________________________________________________________________________

Address: _________________________________________________________________________

City: ___________________________ State: ______ Zip: ___________  Country:______________

Home Phone: _________________________________  AHTCA Member #: __________________

Email: ___________________________________________________________________________

Owner's Signature: ____________________________________   Date: ______________________

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