Single Dog Registration Application

pups

Please fill in ALL the Required boxes below
if you are missing information leave it blank 

pups

If you having a problem with this form or have questions or call live line support at 516 942-4395

Dog's names should be unique.

The dog should have at least 2 names up to 30 characters and spaces.

(Example: dog's name is Gizmo, owners name is Bill Jones, and they live on Lenox Rd the dog's name could be;

Gizmo Jones, Bill's Gizmo, Gizmo of Lenox, or Gizmo the Red Nosed Shih Tzu)

If a dog's name is common DRA has the right to add the owners name or numerals or other modifications to the requested name to avoid confusion and duplication
(example: dog's name is Gizmo owners last name is Jones, DRA may issue certificate with the dog's name as Gizmo Jones or Gizmo JonesII

DRA reserves the right to refuse to register the dog with a requested name deemed unacceptable for any reason.

 

PLEASE DOUBLE CHECK THE INFORMATION YOU HAVE ENTERED AS DRA™ IS NOT RESPONSIBLE FOR ERRORS MADE ON THE APPLICATION

If there is a NUMBER in the box that says, "Reserved for DRA use only"on the application you got with your dog place number here if not leave blank and continue below.

YOUR EMAIL ADDRESS: required

Dog's Name : required

Breed: required

Color : required

Sex: required

Date Of Birth (if you are unsure use approximate date) required

Please select an item.  Please select an item.  Please select an item.

Sire (father) Name:

Sire Registration No:

Dam: (mother)

Dam Registration No:

Breeder/Seller Information:

Who owned the Parents of Your dog

Breeder first name:

Breeder last name:

Breeder Address:

Breeder City :

Breeder State:

Breeder Zip:

Breeder Area Code:

Breeder Phone No:

Owner Information: (your information)

First name of Owner: required

Last name of Owner : required

Address Including APT or LOT#: required

City : required

State: required

Zip: required

Area Code: required

Phone No : required

For Security Purposes Re-Enter Your E-Mail: required
Photo Proof Select :

Co Owner First name:

Co Owner Last name:

PLEASE DOUBLE CHECK YOUR INFORMATION!

DRA™ IS NOT RESPONSIBLE FOR ERRORS MADE ON THE APPLICATION

If you have more dogs to register submit this form and come back to this page and start again

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