Australian Cattle Dog PRA Listing
Data Entry Form

Please note that information will be accepted for this listing ONLY by a dogs owner or breeder!!

Your name: Required
Your email address: Required

Dog's registered name Required (please do not include titles)
Dog's call name

Sex:  Male    Female

Color:  Blue    Red

Date of birth (please use Month/Day/Year format):
Date of death (if applicable):
Cause of death (if applicable):

Sire:
Dam:

Owner(s):
Breeder(s):

Registration number:
Registry Body: (ex. American Kennel Club, Canadian Kennel Club, etc.)

Country where born: If other, specify:
Country exported to (if applies): If other, specify:

Tattoo:
Microchip Number and type:

EYE INFORMATION:

If AFFECTED, AGE of ONSET:

This dog is known to be: PRA Clear    PRA Carrier    PRA Affected

If you are submitting this dog only as an OBLIGATE, which of its relatives have you used to determine this status? Please be sure to list dogs name, registration number and relation to the dog you are submitting.

Other information about this dog:

By retyping your name below and clicking the "Submit" button below you agree that all data submitted is accurate, that you are the owner or breeder of the above dog and that you agree to have this information published on the web

I, , agree that all data submitted in this email is accurate, that I am the owner or breeder of the submitted dog and that I agree to have this information published on the web

Last Updated
05-December-2003

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