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REGISTRATION SERVICESPackage details on reverse side. Select one of the five registration services below. Your dog’s pedigree may be added to any registration option below!
CANINE SECTION USE BLACK INK ONLY TO COMPLETE THIS APPLICATION.
FOR MORE INFORMATION ABOUT CANINE REGISTRATION, VISIT CKCUSA.COM/K9REG.DOWNLOAD ADDITIONAL CKC REGISTRATION FORMS AT CKCUSA.COM/FORMS.
MALEFEMALE
BLOODLINE (optional) BIRTHDATE (MM/DD/YY) SEX BREEDER NAME (optional)
MICROCHIP ID # (optional) DNA CERTIFICATION # (optional) TATTOO # (optional)
BREED COLOR MARKINGS (optional)
NAME OF DOG (30 characters or less; use one box per letter, including punctuation) CALL NAME (for dog tag)
OWNER SECTION MUST BE 18 OR OLDER
PARENT SECTION
PAYMENT SECTION U.S. FUNDS ONLY
CANINE REGISTRATION APPLICATION
PAYMENT TYPE CHECK MONEY ORDER VISA MC DISC AMEXTOTAL PAYMENT AMOUNT .$
FIRST NAME MI LAST NAME
ARE YOU AN EXISTING CKC MEMBER? CHECK TO INDICATE IF YOUR ADDRESS HAS RECENTLY CHANGEDSELECT ONE: MR. MS. MRS. NO YES
CARD NUMBER EX. DATE (MM/YY) BILLING ZIP
CARDHOLDER FIRST NAME (print) LAST NAME (print)
CARDHOLDER SIGNATURE DATE (MM/DD/YY)
Submit this registration application by mail, fax, or email to:CONTINENTAL KENNEL CLUB, INC.
P.O. BOX 1628 - Walker, LA - 70785 phone 1-800-952-3376 fax 1-888-470-7813
email [email protected] web www.ckcusa.com©2018 CONTINENTAL KENNEL CLUB INC. ALL RIGHTS RESERVED
AP-K9-006.09-0918
CKC MEMBER# (optional)
MAILING ADDRESS CITY STATE
ZIP CODE EMAIL ADDRESS
CHECK IF THIS IS ALSOYOUR BILLING ADDRESS
DATE (MM/DD/YY)
OWNER SIGNATURE
By signing this application, I do hereby certify that all information provided for this canine and on this application is accurate and true. I acknowledge and agree that this application and all documentation submitted along with this application, become the property of Continental Kennel Club upon receipt. I further agree to abide by all current CKC Rules, Regulations, and Guidelines.
PHONE NUMBER (daytime)
Foreign Registration Fee $10.00(if registered outside of U.S. territory)
Canine Companion Package (A) $29.99 Canine Protection Package (B) $49.99 Canine Development Package (C) $69.99
Standard Registration (CKC certificate) $15.00 Photo Registration (CKC Certificate & Photo ID) $25.00
(2 3 generation) $10.00(4 5 generation) $20.00
Please, select a tag color using check boxes in product section on right.
Prices and services are subject to change without notice. For a current list of service options, visit www.ckcusa.com. If you wish to apply with a co-owner, please contact the CKC Customer Service Center to request the Co-Ownership Authorization Form. I understand that by providing my email address, I will receive email communications
from CKC, which I can opt-out of at any time.
This application is for official CKC registration of a canine for which one or both of the parents are registered with CKC or a CKC-recognized registry. If a parent is registered with CKC, provide its CKC number in the PARENT SECTION below. If a parent is registered with a CKC-recognized registry, you must submit official registration documentation from the registry along with this completed form. Acceptable documentation is an official club registration certificate or pedigree. For a current list of CKC-recognized registries, visit ckcusa.com/ABV. This application is not valid in Canada.
IF THE CANINE IS REGISTERED WITH A CKC-RECOGNIZED REGISTRY OR CLUB, YOU MUST SUBMIT A COPY OF THE DOG’S CERTIFICATE OR PEDIGREE FROM THE CKC-RECOGNIZED CLUB, ALONG WITH THIS CANINE APPLICATION.
SIRE NAME DAM NAME
SIRE CKC# DAM CKC#
Check this box if sire is registeredwith a CKC-recognized registry.
(provide documentation)
Check this box if dam is registeredwith a CKC-recognized registry.
(provide documentation)
Visit shop.ckcusa.com to view details and images of product options below.
CANINE CARE PRODUCTS
$34.95
$6.95
$9.95$12.95
$35.00$11.95
CKC Dog Tag Blk Pink Blue Grn Prp CKC Logo Dog Leash (6’) Adjustable CKC Snap Collar (12” - 19”)
The Super Simple Guide to Hou setr aining Buddy-ID Mini Microchip Kit by Microchip ID Systems Dog Clicker Training Kit Plus by Karen PryorThe How of Bow Wow Training DVDDog Training in 10 Minutes a Day $19.95
$35.00
CONTACT 1-800-952-3376 [email protected]
www.ckcusa.com 1-888-470-7813
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