single dog registration form - ultimate breeder...

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DISCLAIMER: I agree that it is my sole responsibility to accurately document my animals registration information onto this form. APPLICATION DATE ULTIMATE BREEDER KENNEL CLUB SECTION 1: INSTRUCTIONS SECTION 2: OWNER/CO-OWNER INFORMATION SECTION 3: REGISTERED DOG INFORMATION SINGLE DOG REGISTRATION FORM OWNER’S INITIALS OWNER’S INITIALS / / Breed: Breed type: Bloodline: / / D.O.B: 408 N EARL AVE LAFAYETTE, IN 47904 UBKCREGISTRY.COM Dog's name as shown on existing registration certificate (Max 30 characters including spaces) Dog's chosen call name Current Residing Address: City: Zip: Phone: Email: Owner’s Full Name: State: Signature of current Owner: X Signature of current Co-Owner: X Yes No Current Residing Address: City: Zip: Co-Owner’s Full Name: State: Color: Gender: Microchip # Tattoo #: Genotype #: DNA Profile #: Co-Owner, will both Owners’ signatures be needed if the Dog is sold? Certificate of Ownership (Pedigree not required, does not need to be purebred) Yes No Co-Owners signatures required if bred or litter registration applied for? STEP 1: Please fill the front and back of this application completely, providing correct information and spelling. All information provided will be recorded exactly as submitted on the application. STEP 2: Picture is REQUIRED for registration! Please provide a printed picture of the dog(s)being registered and submit it with this application. The dog should be front facing in the picture with no voids or obstructions such as a leash, arms, legs or other animals. Pictures must be of a high mega-pixel quality and resolution. No cell phone pictures will be accepted. STEP 3: Provide a minimum (3) generation pedigree from an approved registry, with legible registration number which has been issued by one of the following approved registries: ABKC, ADBA, UKC, AKC, ACA, IKC, BBC or BBCR. Shorty Bull applications will only be accepted when accompanied with a BBC or BBCR registration. STEP 4: Provide your payment information when submitting your application. Submit your Credit/Debit card information on reverse side. The name on the Credit/Debit card information submitted, must match the name of the applicant. Mail your application, picture and copy of registration to the UBKC mailing address below. If a Co-Ownership is currently governing the existing registration from another registry, both Co-Owners will need to submit separate applications for this single registration. Otherwise, one Owner may provide a signed and notarized authorization agreeing to the new registration with the UBKC. Dog's name as shown on existing registration certificate (Max 30 characters including spaces) Dog's name as shown on existing registration certificate (Max 30 characters including spaces) SIRE/DAM INFO: Attach copy of front and back of at least a 3 generation pedigree certificate. Acceptable Registries: ABKC, ADBA, UKC, AKC, ACA, IKC, BBC or BBCR.

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Page 1: SINGLE DOG REGISTRATION FORM - Ultimate Breeder …ubkcregistry.com/.../2016/05/UBKC-Single_dog_registration_form-v0… · acceptable registries: abkc, adba, ukc, akc, aca, ikc, bbc

DISCLAIMER: I agree that it is my sole responsibility to accurately document my animals registration information onto this form.

APPLICATION DATE

ULTIMATE BREEDER KENNEL CLUB

SECTION 1: INSTRUCTIONS

SECTION 2: OWNER/CO-OWNER INFORMATION

SECTION 3: REGISTERED DOG INFORMATION

SINGLE DOG REGISTRATION FORM

OWNER’S INITIALS

OWNER’S INITIALS / /

Breed: Breed type: Bloodline:

/ /D.O.B:

408 N EARL AVE LAFAYETTE, IN 47904UBKCREGISTRY.COM

Dog's name as shown on existing registration certificate (Max 30 characters including spaces)

Dog's chosen call name

Current Residing Address:

City: Zip:

Phone: Email:

Owner’s Full Name:

State:

Signature of current Owner:

X

Signature of current Co-Owner:

X

Yes No

Current Residing Address:

City: Zip:

Co-Owner’s Full Name:

State:

Color:

Gender: Microchip #Tattoo #:Genotype #:DNA Profile #:

Co-Owner, will both Owners’ signatures be needed if the Dog is sold?

Certificate of Ownership (Pedigree not required, does not need to be purebred)

Yes No Co-Owners signatures required if bred or litter registration applied for?

STEP 1: Please fill the front and back of this application completely, providing correct information and spelling. All information provided will be recorded exactly as submitted on the application.

STEP 2: Picture is REQUIRED for registration! Please provide a printed picture of the dog(s)being registered and submit it with this application. The dog should be front facing in the picture with no voids or obstructions such as a leash, arms, legs or other animals. Pictures must be of a high mega-pixel quality and resolution. No cell phone pictures will be accepted.

STEP 3: Provide a minimum (3) generation pedigree from an approved registry, with legible registration number which has been issued by one of the following approved registries: ABKC, ADBA, UKC, AKC, ACA, IKC, BBC or BBCR. Shorty Bull applications will only be accepted when accompanied with a BBC or BBCR registration.

STEP 4: Provide your payment information when submitting your application. Submit your Credit/Debit card information on reverse side. The name on the Credit/Debit card information submitted, must match the name of the applicant. Mail your application, picture and copy of registration to the UBKC mailing address below.

If a Co-Ownership is currently governing the existing registration from another registry, both Co-Owners will need to submit separate applicationsfor this single registration. Otherwise, one Owner may provide a signed and notarized authorization agreeing to the new registration with the UBKC.

Dog's name as shown on existing registration certificate (Max 30 characters including spaces)

Dog's name as shown on existing registration certificate (Max 30 characters including spaces)

SIRE/DAM INFO: Attach copy of front and back of at least a 3 generation pedigree certificate. Acceptable Registries: ABKC, ADBA, UKC, AKC, ACA, IKC, BBC or BBCR.

Page 2: SINGLE DOG REGISTRATION FORM - Ultimate Breeder …ubkcregistry.com/.../2016/05/UBKC-Single_dog_registration_form-v0… · acceptable registries: abkc, adba, ukc, akc, aca, ikc, bbc

SECTION 6: SELECTED SERVICES (Add check boxes accourdingly) SECTION 7: PAYMENT INFORMATION

INITIALS

- Single Dog Registration - Kennel Name Registration - Certified Purebred Registration - Late Registration fee* - Certificate Protection Binders - UBKC Certified Breeders List 6 months+

- UBKC Certified Breeders List 12 months+

- UBKC Web-store rotating graphic banner++

- Rush Fee (processing within 5 business days) - Overnight Shipping with Tracking - DNA Profiling** + Veterinary fees - Genotype Mapping Sequence* + Veterinary fees TOTAL AMOUNT DUE

$20.00$20.00$20.00$40.00$35.00$30.00$50.00

$250.00$20.00$30.00$50.00

$160.00

Visa MasterCard

YesNo

DiscoverCheckAmex

Cashiers CheckMoney Order

M M Y Y

ULTIMATE BREEDER KENNEL CLUB

(Continued, Page Two)

SINGLE DOG REGISTRATION FORM408 N EARL AVE LAFAYETTE, IN 47904

UBKCREGISTRY.COM

Authorizing Signature:

Address: (PO Boxes are not accepted as a billing address)

City: Zip:

Billing #:

Date:

X

State:

Signature of current Owner:

X

Signature of current Co-Owner:

X

Method:

Name on Card:

Card Number:

Exp: CSC:

* Price charged per dog being registered

** DNA Profiling with the UBKC is required to be conducted through a State Licensed Veterinarian. This is to eliminate paper-hanging and falsification of pedigree registrations. Patent Protected Service with the USTPO Governmental Authorities. No other registry can legally require this service.+ UBKC Certified Breeders list will allow you to place your kennel or website link, name, contact information and litter information directly on the UBKC website.++ Rotating graphics banner will get your image/banner with a link leading to your website, posted directly on the home page of the UBKC online Web-store. 90 Day validation. (Free banner production included)

DISCLAIMER: I understand that UBKC reserves the sole right to revoke any registration in part or in whole at any time, for any reason. I understand this is an application for registration and that no guarantee of permanent registration is promised or implied. It is understood that all temporary puppy papers must be submitted for permanent registration within six (6) months of the recorded D.O.B. Late registration applications will incur a late fee of no less than $40.00 (forty-dollars) per permanent registration application. Rules, policies and fees are subject to change without prior notice. UBKC reserves the right to reject, revoke or amend any and all registration applications and certificates consistent with its current rules and policies without prior notification to the registered Owner(s).ULTIMATE BREEDER KENNEL CLUB

408 N EARL AVE LAFAYETTE, IN 47904

MAIL FORM TO:

COPYRIGHT 2015, ULTIMATE BREEDER KENNEL CLUB INC. | UBKCREGISTRY.COM | FACEBOOK.COM/UBKCREGISTRY

SECTION 4: INSTRUCTIONS

SECTION 5: PHOTOGRAPH RELEASE

The UBKC reserves the right right to reject any application for registration(s) for any reason. Such registration rejection may apply when the animal being registered may not conform to breed standards or may be proven non-genetically purebred through DNA testing. Additionally, the UBKC reserves the right to adjust or alter registration rules, guidelines and compliance requirements.

The UBKC reserves the right to revoke any awarded registration at any time without notice and for any reason. In no way is it implied anywhere on any UBKC document or digital media that such revocation of registration will in any way make me eligible for a refund of registration fees. There will be no refunds granted for any registration that may become revoked after having been awarded.

By signing this registration application, I hereby agree that any/all photographs I submit to the UBKC (Ultimate Breeder Kennel Club), will become the property of the UBKC and will not be returned, even upon my request. I hereby grant nonrevocable permission to the UBKC to use photographs I submit of my dog in all forms of media, for any promotional purrposes including, but not limited to publicity, online advertising, display advertising, and editorial use.

By signing this application I agree to abide by all UBKC rules, regulations, and breeding policies; including the UBKC Breeder’s Moral Code of Ethics and all State regulations and laws concerning animal care. Additionally, I agree to provide regular and proper medical care for any/all of my animals registered with the UBKC, aka Ultimate Breeder Kennel Club.

I understand that this application is submitted for consideration and is not guarantee of Permanent Registration with Ultimate Breeder Kennel Club.UBKC reserves the right to reject or refuse any application for permanent registration, with cause for explanation.

I hereby consent to the above referenced animal’s photograph(s) being used by UBKC for advertising, publicity, commercial or other business purposes of which may produce a profit or income to which I hereby forfeit any and all claim to payments, royalties or commissions. I hereby give UBKC perpetual, irrevocable, nontransferable, paid-up right and license to use and copy photographs or images of the above referenced animal.

(Must complete all fields)

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