| OWNER
INFORMATION |
PET
INFORMATION |
| Name:
|
Tattoo
Number:
|
| Address:
|
Indicate
all letters, numbers, and symbols that
physically appear on this pet. |
| City:
|
| State:
Zip:
|
Microchip
Implant Number:
|
| Telephone
(H):
|
Company:
|
| Telephone
(W):
|
Pet's
Call Name:
|
| Cell:
Pager:
|
Dog
Cat
Other
|
| Email:
Fax:
|
Specific
Breed (s):
|
IMPORTANT:
In case of emergency, give name of relative/
friend at an address
OTHER THAN YOURS. THIS
MUST
BE FILLED IN. Additional names can be listed
below. |
Color
(s):
|
| Special
Markings:
|
| Name:
|
| Telephone
(H):
|
Emergency
Data:
|
| Telephone
(W):
|
| TATTOOER
/ IMPLANTER INFORMATION |
Prescription
Names & Dosage:
|
| NDR Agent
# |
| (To
be completed only by Authorized Agent) |
Allergies:
|
| Name:
|
Veterinarian
Name:
|
| Address:
|
Veterinarian
Phone:
|
| City:
|
|
|
|
|
| State:
Zip:
|
|
|
|
|
1) I, the
above named owner, empower NDR to authorize emergency pet care, in my
name, should my pet
become injured and I cannot be reached. (Check
this box if you do not agree to this provision
NO )
|
2)
I understand that NDR is not responsible for any lost, late, non-delivered,
or misdirected mail.
|
3)
I will use the NDR official Change Of Information Form to keep NDR advised
of my current information
(Available online Here
and enclosed in confirmation packet)
|
| 4)
I also hereby swear that the above is true and correct and that I am
the legal owner of the above-named pet. |
Use ONE
form for ONE pet. Submit form as needed
for multiple pets. There is a $6.00 service
charge
for processing and handling. When ANY information
is changed, EVERY tattoo/microchip implant
MUST be referenced. NDR
assumes no responsibility if info is not provided. |
|
|
All
Material and contents (except where quoted from other sources) Copyright
© 2004 National Dog Registry. All rights reserved.
Reproduction or other use without the express written permission of
National Dog Registry is prohibited. |