BCSA Futurity Pre-Whelp Nomination Form

Dam Registered Name*

Dam's Call Name*

Dam's AKC Number*

Dam's Birth Date*

Sire Registered Name*

Sire's Call Name*

Sire's AKC Number

Sire's Birth Date*

Sire's Owner(s):*

Breeding Dates*

Breeder(s) of Record*

List the first BCSA member of record as contact, followed by the other Breeders.

Breeder's Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Breeder's Email Address*

Breeder's Phone*

Whom would you like to judge at the Futurity?

Conformation

Herding

Name*

First Last

Signature*

Health Screening Information

I have mailed or emailed copies (BCSA will not be responsible for originals) of ALL health screenings I would like listed on both Dam and Sire.

Pre-Whelp Nomination Fee*

Total

$0.00