Previous Litter Number from the same cross if known___________________

Sire's Registered Name________________________________AHTCA Reg #________________

Owned By:_________________________________________________Member #____________
                                                                                                                          (if available)
Address:______________________________________________________________________

City_______________________________________________State________Zip_____________

Dam's Reg Name___________________________________AHTCA Reg #__________________

Owned By:_________________________________________________Member #____________
                                                                                                                          (if available)
Address_______________________________________________________________________

City______________________________________________State________Zip______________

Date(s) bred____________________________________________________________________

Date Whelped_______________________________________Number Born_________________

Males: Black/Tan_____Black/Red_____Solid Tan_____Solid Red_____More than*10%White_____

Females: Black/Tan____Black/Red_____Solid Tan____Solid Red_____More than*10%White_____

*More than 10% white would also include white appearing in places other than chest or toes.
Please enclose $15.00 for a litter of 3 or more, $5.00 for one pup and $10.00 for 2 pups.

Are either the Sire or Dam Registered with any other clubs?
If so please give the name of the organization and the registration number.
Sire:__________________________________________________________________________

Dam:_________________________________________________________________________

As the owners of the Dam, I hereby certify this information to be true and correct.

Signed____________________________________________________Date________________

Signed____________________________________________________Date_________________
           
                                           
Home of the black and tan Jack Russell
Application for AHTCA Litter Registration
American Hunt Terrier Club Association, INC
607 Nichols Bluff Road Brantley, AL 36009
%Rena Perrett Compton
Phone: 334-527-3804    Email renapcompton@yahoo.com
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