ENTRY FORM

Full name of the dog:

Name of kennel:

Surname of the dog semen owner:

First name of dog semen owner:

Full mailing address of the dog semen owner:

Email address used in the reservation:

Dog semen owner phone number:

Date of birth of the semen owner:

Dog registration number in the studbook:

Dog microchip number:

Date of birth of the dog:

Dog breed:

Dog weight:

Coat color of the dog:

How many times did the dog cover? How many of these matings were successful? (E.g. 5/4):

When was the dog last mated and with what result?

In what environment does the dog live? Describe contact with other dogs:

Describe how and what the dog is fed.

Vaccination (name of vaccine, date):

Date of last deworming of the dog:

Describe the physical load of the dog (training, walks, how often and how intensively):

Describe diseases, operations and medications (even local). Indicate mainly possible gestagens, corticosteroids, cimethidine, amphotericin, nesteroids.

Indicate the date of X-ray of dog´s pelvis.

If the dog has previously undergone semen analysis, indicate the date and result.

Describe the reason for the current semen collection. If the reason is export, indicate the destination country.