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Pedigree Entry Form

Enter / Update Dog Information for CCCI Health Database

Fields Marked with a Red * are required

Title

Registered Name *

Suffix

Call Name

Registration Number *

Gender

Birth Date

Color

Coat Textrure

Microchip Number

DNA Profile Number

Stud Book Date

Sire Registered Name

Sire Registration Number

Dam Registered Name

Dam Registration Number

OFA Hip Number

OFA Elbow Number

OFA Patella Number

OFA Thyroid Number

OFA Cardiac Number

Cerf Exam Date

Cerf Breeder Option Diagnosis

Cerf History

Owner(s)

Primary Owner Email

Owner Website / URL

Breeder(s)

Primary Breeder Email

Breeder Website / URL

Attach Photo File

Drag and drop files here or Browse

Attach Pedigree File

Drag and drop files here or Browse

Notes

Form Submitter Email *

Form Submitter Name *

Website