ASA Breeding Request Form

STOP and CHECK!

Prior to filling in this form, you must have the following items ready to send along with this form: • Hip and Elbow clearances • Copy of your FCPR registration, showing you as owner • Copy of your AKC registration, showing you as owner • AKC DNA parentage test if your female is foreign or Canadian born • Cerebral Dysfunction test, if one parent was a carrier of CD • 2 show evaluations or a completed BAC evaluation • Temperament test within 6 months Please refer to the website under PUPPIES AND BREEDING, if you have any questions.

Today's Date*

Formal Name of Female*

FCPR Registration Number*

AKC Registration Number*

Expected month of next heat cycle (MUST BE A MINIMUM OF 3 MONTHS IN THE FUTURE)*

OFA Hip X-ray result*

OFA Elbow X-Ray result*

Cerebral Dysfunction test result

First Breeding Request?*

Yes
No

If No, Date of Birth of Previous Litter

Owner of breeding female*

First Last

Owner's Email*

Please give the BAC your first and second choice of male below.

Name of Preferred Stud

Preferred Stud's Registration Number

Name of Alternate Stud

Alternate Stud's Registration Number

Use the following lines for remarks or any other additional information, including the reason for your first and second choices:

All owners of the above named Bitch need to be members of the ASA and are bound by the breeding requirements of the ASA Code of Ethics. Permission needs to be requested no later than 3 months prior to the expected heat cycle. Permissions are valid for 12 months after the date they were granted. A 6-month extension can be requested once by mail. After that, a new breeding request must be submitted.