INTERNATIONAL GERMAN COOLIE SOCIETY AND REGISTRY

LITTER REGISTRATION APPLICATION

Submit this form together with the appropriate fee to receive an Individual Registration Paper for each live puppy listed in the appropriate space 3 clear photographs (both sides and front) MUST be submitted with this application of Sire/Dam and ALL puppies Copy of Sire and Dam's pedigree MUST accompany this form, along with any information of past lineage (breeder/owner name, color and description of dog) Litter owner MUST be a member of the Society to register a litter with IGCS&R (Litter owner is the owner of the dam at time of whelping) If Sire/Dam has produced 7 or more litters that Sire/Dam MUST be DNA Profiled Make Checks or Money Order payable to IGCS&R, or email for information as to how to send payment by paypal

Send Application To: IGCS&R Business Office Ida Parmer 1139 LCR 454 Groesbeck, Texas 76642 (254)562-3078 www.coolieregistry.com

OFFICE USE ONLY     Paid No. ______________ Date _________________ Reg No. ______________ Date _________________

Litter Registration Fees

Litter Ages: Member Pay: Litter Age 0-6 months $5.00 per pup - registered individually, or $20.00 per litter Litter Age 6-12 Months $7.00 per pup Litter Age 12-24 Months $10.00 per pup Litter Age 24 & Older $25.00 per pup FOUNDATION FEE WAVED

Section 1 - to be completed by Sire Owner

Name of Sire Registration Entity & Number of Sire Color (include any unusual markings) Name of Owner of Sire Address Contact Number(s) Membership Number DNA Status - Y or N Email Did you witness mating?  Y or N Is this Sire leased?   Y or N Date

I (we - if co-owned), further certify that I/we was/were the owner, co-owner, or lessess of the sire at the time of mating. ____________________________________________________________________________________________ Sire Owner's and Co-Owner's Signature(s) (or Lessee)

Section 2 - to be completed by Dam Owner

Date(s) of Mating DATE OF WHELPING (MMDDYY) Did you witness mating? Y or N Name of Dam Registration Entity & Number of Sire Color (include any unusual markings) Name of Owner of Dam Address Contact Number(s) Membership Number DNA Status - Y or N Email Is this Dam leased?  Y or N Date Country litter whelped in

I (we - if co-owned), further certify that I/we was/were the owner, co-owner, or lessess of the Dam at the time of mating. ____________________________________________________________________________________________ Dam Owner's and Co-Owner's Signature(s) (or Lessee)

I (we) testify that all data submitted is correct.  I (we) understand that all applications become the property of IGCS&R.  I further certify that I was the owner, co-owner, or lessee of the dam listed on this application on the date of birth of the litter and that this dam was mated only to the sire listed on this application.  Should information in this application prove false, applicant will indemnify and defend IGCS&R and hold it harmless against any resulting loss.  The lineage of your dog can be determined with certainty by DNA testing.  I (we) further understand that as an owner of an IGCS&R registered litter, I (we) agree to abide by the IGCS&R Code of Ethics, Breed Standard, and rules of the Coolie Registry, and disciplinary action, if necessary, as determined by the IGCS&R.

SECTION 3 - LIST ALL PUPPIES - LIVE OR OTHERWISE

Name of Puppy Sex M=Male F=Fem Color (body) B=Black Br=Brown DBl=Blue Dbr=Lilac e/e=True red Pattern S=no other color I=Irish P=Piebald XP=Extreme Pie MM=Double merle Mm=Merle Sbl=Sable Sdl=Saddle Tan=Tan point Eye Color R=Right L=Left Bl=Blue Gr=Green Brn=Brown A=Amber C=Cracked S=Split M=Marbled Ear set B=Bent D=Drop P=Pricked U=Unk Tail F=Full D=Docked NB=Natural bob Disposition D=Died C=Culled L=Live S=Sold R=Retained Fencepost BladeOgrss EXAMPLE M BR I, Mm, Tan R-Bl/L-M U-too yng F L/S

I (we) testify that all data submitted is correct.  I (we) understand that all applications become the property of IGCS&R.  I further certify that I was the owner, co-owner, or lessee of the dam listed on this application on the date of birth of the litter and that this dam was mated only to the sire listed on this application.  Should information in this application prove false, applicant will indemnify and defend IGCS&R and hold it harmless against any resulting loss.  The lineage of your dog can be determined with certainty by DNA testing.  I (we) further understand that as an owner of an IGCS&R registered litter, I (we) agree to abide by the IGCS&R Code of Ethics, Breed Standard, and rules of the Coolie Registry, and disciplinary action, if necessary, as determined by the IGCS&R.

_______________________________________________________________________________________________ Name of Owner of Dam at time of whelping - Date of signature