APPLICATION FOR SINGLE REGISTRATION - United …

1 Sole Signatory InformationBreed: Variety (if applicable) APPLICATION FOR SINGLE REGISTRATIONP lease allow 4 to 6 weeks for carefully complete this form. UKC is not responsible for errors caused by illegible handwriting. Incomplete applications may result in processing delays. Dog NameA dog s name cannot be changed once it has registered offspring with UKC or attained a UKC title. Do not use over 30 characters and spaces. Dog s name must consist of two words or Sole Signatory s Last Name will be added to names containing only one word. Any punctuation is considered a reserves the right to deny any name, for any reason. Any name deemed discriminatory or derogatory towards race, religion, gender, sexual orientation, disability, or national origin will be this dog have a Temporary Listing number?

2 No Yes If yes, TL# _____Tattoo_____ Microchip _____ Is dog spayed/neutered? No yes,provide date _____/_____/_____ Owner/Registrant(s) of Sire at time of breeding (if available)_____Owner/Registrant(s) of Dam at time of breeding (if available)_____Step 2 Must be filled out by the Sole Signatory of this dog. If more than one individual is being listed on the dog s record, the Sole Signatory Designation Form must be completed. This form can be downloaded at INFORMATION AND RULES GOVERNING SINGLE REGISTRATION1. To be considered for UKC SINGLE REGISTRATION , all applications must be accompanied by proof of REGISTRATION froma UKC-acknowledged registry, as well as a complete three generation pedigree. SINGLE REGISTRATION rules andrequirements may vary according to breed. 2. Dogs under one year of age with two UKC registered parents require the signature of the owner(s)/Signatory ofthe dam at the time of breeding indicating that the individual has permission to SINGLE register this dog with UKC,before the dog will be considered for UKC Dogs exhibiting breed standard disqualificationswill be denied REGISTRATION but may apply for a PerformanceListing number.

3 All dogs accepted for Performance Listing (PL) are eligible to compete in UKC PerformanceEvents, but not all breeds are eligible for every event. Please refer to the UKC website for rules and regula-tions for individual UKC Licensed Performance events and breed eligibility requirements; as well as breedstandards and disqualifications. Color Sex_____ Date of Birth _____/_____/_____Dog Information All breeds are NOT eligible for SINGLE REGISTRATION . Refer to the UKC website for breed specific requirements, photo requirements (if any) and acknowledged 1 Continue to Steps 3-4gmonthdayyearPrint the name of the Sole Signatory _____By signing this APPLICATION I agree to abide by all UKC rules, regulations, and policies; also understand that I am responsible for all information contained herein. All applications and photos become the property of UKC and are not returned.

4 UKC reserves the right to refuse an APPLICATION as well as correct or revoke any REGISTRATION at any further attest that the dog for which SINGLE REGISTRATION is being applied: a) meets the UKC breed standard, as interpreted by UKC, for the breed for which it is being registered; b) does not exhibit any of the breed standard disqualifications; andc) is a good specimen of that breed. I give permission to United kennel club to use photographs of my dog in all forms of media, and promotional purposes, including but not limited to, publicity, display, advertising, education and editorial of the Sole Signatory (Required)_____Current Address_____UKC is NOT responsible for undeliverable mail due to incomplete mailing _____State/Province _____Postal Code _____ Country _____Phone # ( _____ )_____ Email Address _____Sole Signatory (Only one individual may be listed as the Sole Signatory)FO6 ADM-A / Rev. 4-2017 Great Grandsire _____UKC No. _____Grandsire _____UKC No. _____Great Granddam _____UKC No.

5 _____Sire _____UKC No. (if available)_____Great Grandsire _____UKC No. _____Granddam _____UKC No. _____Great Granddam _____UKC No. _____Great Grandsire _____UKC No. _____Grandsire _____UKC No. _____Great Granddam _____UKC No. _____Dam _____UKC No. (if available)_____Great Grandsire _____UKC No. _____Granddam _____UKC No. _____Great Granddam _____UKC No. _____Checks and money orders must be payable in US funds and made to the order of: United kennel club Attn: UKC SINGLE Reg Dept 100 E. Kilgore Rd. Kalamazoo, MI 49002-5584 Phone: (269) 343-9020 Fax: (269) 343-7037 1-3 $35 each _____ 4-8 dogs ..$25 each _____ 9 or more dogs ..$20 each _____(To the same Sole Signatory)* Next Day Air Service ..$60(Available for physical mailing addresses in Continental US only / Saturday delivery is not available /No Box addresses.)* Expedited Service ..$40(Upon receipt at UKC, processed and returned within five business days, with tracking email address must be provided.)

6 Available in Continental US only.)* Rush Service ..$30(Processed within five business days of receipt at UKC/ does not include time in transit.)GRAND TOTAL$_____UKC Office Use Only Declined ApprovedAuth # _____In Date_____ Fee _____ Check No. _____Init _____Ctrl # _____Single approved _____Step 3 Step 4 Fees(Subject to change without notice)PedigreeForward a copy of your official/certified pedigree or indicate your dog s 3 generation pedigree below. Please be sure that handwriting is legible and photocopies areof sufficient quality and size for reviewing. Include any UKC REGISTRATION Numbers, if applicable; but do not include titles or degrees. For non UKC registered dogs, the pedigree willappear exactly as it is provided below. UKC is not responsible for information that is not provided. Information not provided will be indicated as Not Provided on the pedigree. Credit Card Information (Major Credit Cards Accepted)Cardholder s Name _____Cardholder s Signature _____Cardholder s Address _____City/State/Province/Postal Code _____Credit Card Number_____Exp Date_____When requesting an accelerated service, write NEXT DAY AIR, EXPEDITED or RUSH on the outside front of the envelope.

7 Faxed or emailed applications within the continental US will be chargedan EXPEDITED Service Fee of $40. applications outside the Continental US will be charged a RUSH service fee of $30.