NON-PUREBRED
CANINE REGISTRATION APPLICATION
Complete this Non-Purebred Canine Registration Application to apply for registration of mixed-breed, adult canine for which the original registration records have
been lost or ancestry is undocumented. The owner of the applicant dog and two witnesses of legal age, must verify the information provided. In addition, three
photographs of the dog must be submitted with this application, which meet the requirements and guidelines on opposite side of application. Not valid in Canada.
CANINE SECTION
NAME OF DOG (one character per box including spaces and punctuation)
COLOR
MALE
FEMALE
SEX (check one)
MARKINGS (optional)
MIXED BREED (designer name or two breeds mixed)
BREEDER (optional)
BIRTHDATE (mm/dd/yyyy)
MICROCHIP # (optional)
BLOODLINE (optional)
DNA CERTIFICATION # (optional)
SIRE NAME (optional)
TATOO # (optional)
DAM NAME (optional)
OWNER SECTION
MUST BE 18 OR OLDER
If you are a CKC Member and your address has changed,
please provide your previous address on the lines below.
MY ADDRESS
HAS CHANGED
OWNER NAME (must be 18 years or older)
PREVIOUS ADDRESS
MAILING ADDRESS
PREVIOUS CITY
CITY
STATE
STATE
PREVIOUS PHONE NUMBER
PHONE NUMBER
ZIP
ZIP
MEMBER NUMBER (optional)
COUNTRY (if not U.S.)
By signing this application, I do hereby certify that all information provided on this
application and submitted along with it, is accurate and true. I acknowledge and agree
that this application and all documentation submitted along with it become the property
of CKC Inc. upon submission. I further agree to abide by all current CKC Rules,
Regulations, and Guidelines.
E-MAIL ADDRESS (optional)
XOWNER SIGNATURE
DATE (mm/dd/yy)
WITNESS SECTION
MUST BE 18 OR OLDER AND U.S. CITIZEN
Two witnesses of legal age (18 or older) are required to provide their name, contact information, and signature in the section below. The witnesses understand that by signing
this application, they attest to the accuracy of information contained on this application along with any/all documentation supplied by the owner of the applicant canine.
WITNESS #1 NAME
WITNESS #2 NAME
#1 MAILING ADDRESS
#2 MAILING ADDRESS
#1 CITY/STATE/ZIP CODE
#2 CITY/STATE/ZIP CODE
#1 DAYTIME PHONE NUMBER
#2 DAYTIME PHONE NUMBER
WITNESS #1 SIGNATURE
DATE (MM/DD/YY)
WITNESS #2 SIGNATURE
DATE (MM/DD/YY)
Service options and fees are subject to change without notice. Visit our website
at www.ckcusa.com for a current list of registration services, options, and fees.
SERVICE SECTION
REGISTRATION OPTIONS (must choose one)
CANINE CARE PRODUCTS
 Canine Companion Package A
$29.99  Standard Registration
 Canine Protection Package B
$49.99
 Canine Development Package C
Registration Fee
$69.99  Foreign
Check if applicant resides
Dog Tag Blk Pink Blue Grn Prp
 everydog Magazine Subscription (1YR)
 BuddyID-Mini Microchip & MicrochipID Kit
 Adjustable CKC Logo Snap Collar (12”-19”)
 CKC Logo Dog Leash (6ft.)
 The Dog Training Handbook
 Designer Breed Dogs (handbook)
(registration certificate/photoID/dog tag/everydog
single-issue/eNewsletter/Dogwise Solutions Booklet)
(ALL contents of Package A plus BuddyID-Mini
Microchip & MicrochipID Kit)
(ALL contents of Package B plus Dog Clicker
Training Kit by Karen Pryor)
(certificate of registration/eNewsletter)
 Photo Registration
(certificate of registration/photoID
card/eNewsletter)
$15.00
$25.00
$10.00
outside of U.S. territory.
U.S. FUNDS ONLY
PAYMENT SECTION
TOTAL PAYMENT AMOUNT
$6.95
$24.99
$35.00
$9.95
$12.95
$19.95
$14.95
$
.
CARD NUMBER
X
CARDHOLDER SIGNATURE
© 2015 CONTINENTAL KENNEL CLUB INC. ALL RIGHTS RESERVED
PAYMENT TYPE
EXP. DATE
CHECK
MONEY ORDER
BILLING ZIP
CARDHOLDER NAME (print)
VISA
MC
DISC
AMEX
Submit application with payment, to:
Continental Kennel Club Inc.
P.O. Box 1628 - Walker, LA - 70785
DATE (mm/dd/yy)
AP-MISCK9-001.05-08.15
NON-PUREBRED
CANINE REGISTRATION APPLICATION
PHOTOGRAPH GUIDELINES AND REQUIREMENTS
Please reference the photograph submission guidelines below to complete the CKC Inc. Non-Purebred Canine Registration Application on
the opposite side. Failure to submit proper photographs to represent the applicant canine will result in an incomplete registration process,
requiring that additional information be submitted which may cause a delay in the receipt of registration documentation.
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A minimum of three (3) photographs must be submitted along with the application for registration.
Photographs submitted must include the following views of the applicant canine represented for
registration:
one full left side
one full right side
one full frontal view
All submitted photos must be from the same photo session.
Photos must be taken from eye level with the dog.
(No pictures taken from an overhead angle, diagonal angle, or with the dog turning or moving will be
accepted.)
The dog must be standing in all photos.
No part of the dog can be cut off in any of the photos.
The dog should take up 75% of each photo (no long range photos).
For breeds that require a long or curly coat, the dog’s coat must be in that state and groomed (not
shaven or short).
Dogs in the photographs should appear in good condition with the coat neat, clean, and free of any
obvious diseases, disorders, or parasites.
The following photographs will NOT be accepted:
×
×
×
×
Photographs that are blurry, grainy, too dark, too bright, black and white photos, or discolored
photographs
Dogs that are being held in arms, restrained, dogs that are sitting, or dogs that are lying down
Pictures of dogs that are behind obstructions such as fences, kennels, fence post, tall grass, etc.
Photographs in which a dog has been completely shaved (excluding sporting clips, puppy clips, and
sanitary clips of breeds in which coat types and lengths can still be determined)
© 2015 CONTINENTAL KENNEL CLUB INC. ALL RIGHTS RESERVED
AP-MISCK9-001.05-08.15