Leavitt Bulldog Association 2005

Application for Litter registration

Sire____________________________________________________ Reg. #_______________________________________

 

Dam____________________________________________________ Reg. # ______________________________________

 

D.O.B. of litter to be registered (Month/Day/Year) _______________________________________________

 

Breeder's Name ____________________________________________ Kennel prefix (if desired)_________________________________

 

Address_________________________________________________City_______________________________________________________

 

State_______________________________________________ Zip____________________ Phone#________________________________

 

E-Mail:____________________________________________________ _____________________________________

Please complete the entire form. The recording fee for litter registration is $20.00 U.S. per puppy for litters of 1 or
2 puppies or $30.00 U.S. for litters of 3 or more puppies.
Postal Check or Money Order only made payable to
Marie Morris.

Personal checks cannot be accepted. Please print clearly.

Puppy Data - (Please list all puppies. Photos are not required, but may be submitted voluntarily.

Identify puppy with corresponding puppy # or name. Pictures should be E-mailed.)
*
Pied on white are colored markings on a predominately white background.   Please describe.

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw

 

Cleft
 
Yes / No


Pump Handle____
Bend/Crook _____

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw

 

Cleft
 
Yes / No


Pump Handle____
Bend/Crook _____

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw

 

Cleft
 
Yes / No


Pump Handle____
Bend/Crook _____

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw

 

Cleft
 
Yes / No


Pump Handle____
Bend/Crook _____

Cork Screw_____

Bobbed________

 

 

     

 

   

   

Page 2

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw

 

Cleft
 
Yes / No


Pump Handle____
Bend/Crook _____

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw

 

Cleft
 
Yes / No


Pump Handle____
Bend/Crook _____

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw

 

Cleft
 
Yes / No


Pump Handle____
Bend/Crook _____

Cork Screw_____

Bobbed________

 

Puppy#____

Sex

Color

Jaw

Tail

 

 

Circle one


M      F

Solid______

 

Brindle_____

 

 

*Pied on White

White___

Red___

Grey___

Black___

Fawn___

Other________________
_____________________

Wry Jaw

 

Cleft
 
Yes / No


Pump Handle____
Bend/Crook _____

Cork Screw_____

Bobbed________

(If you have more pups then spaces on the form, print extra of Page 2)
I _________________________________________ certify that I am the breeder of this litter of Leavitt Bulldogs, and affirm that
the above information is true and correct.

Signature________________________________________________________________ Date__________________________  

Leavitt Bulldog Association Registrations  

Marie Morris

P.O. Box 343

Centenary, SC 29519