1. Owner of dog must fill out OWNER OF DOG FORM.

2. Bring the QUICK REFERENCE GUIDE and the NRTA DOG VERIFICATION VET FORM to your veterinarian and have them fill it out.  Return the form from your vet, filled out and signed to the NRTA.

Person applying for dog registration returns the Owners Form, any other pedigree or history information, three photos of the dog taken from the front, side and rear, and proof of origin of the dog. *See Below. Mail all the information along with a 10.00 fee to NRTA 26 Park Drive Rocky Hill, CT 06067  Phone # 860-563-2293
Payment by Money Order or Bank Check only, No Personal Checks

Once all the information has been received and reviewed you will be sent your dog registration certificate or a letter stating why that dog could not be registered.

Thank you,
NRTA

*Proof of Origin

Origin of the dog applies to the first owner and means:

• How was the dog first obtained; purchased, gift, etc
• Where did the dog come from; private owner, breeder, pet store
• Who bred the dog;  Must include Breeders full Name and Address, Kennel Name and Phone
      number if applicable.

Important please read below
Examples:
1. Tom purchased a dog from a Breeder, the Origin of the dog would be the Breeder. The
information that we would need is a copy of your original purchase agreement that shows all the
breeder information, Name, Address etc.
2. Sam purchased a dog from Joe, Joe purchased the dog from Jane, the Origin of the dog would be
from Jane. The information that we would need would be from where Jane obtained the dog. A copy
of her original purchase agreement or a signed notarized statement from Jane listing her purchase
from the breeder along with the breeders name, address and phone number.

Note: If the origin of the dog was from a Pet Store, Broker, Rescue, ASPCA, Shelter, Humane
Society etc. it would not be eligible for registration. Falsification of any information being submitted
will result in immediate rejection into the registry. Scroll down for next page.

Owners Please fill out this Page as completely as possible.

Owners Name _______________________________________________________________________

Address ____________________________________________________________________________

City, State, Zip _______________________________________________________________________

Phone __________________________________E-Mail ______________________________________

BREEDER OR HOW DOG WAS OBTAINED:    This information is required to register a dog. Dogs acquired from Rescues, Shelters, Humane Society's, Pet Stores or the ASPSA are not eligible for registration with the NRTR.  ALSO PLEASE ATTACH PROOF OF ORIGIN OF DOG INFORMATION.  REFER TO INSTRUCTION SHEET.

(From) Name of person or breeder __________________________________________________

Address _______________________________________________________________________

City, State, Zip __________________________________________________________________

Phone __________________________________E-Mail _________________________________

Comments______________________________________________________________________

________________________________________________________________________________

DOG INFORMATION:
How long have you owned the dog__________________________________

Name of Dog___________________________Sex_____Eye color__________Nosecolor_________

Coat color_________________________________Date of Birth_______________Weight_________

Patterns/Markings-(Circle One)  1.Tri-Colored  2.Patches of Color 3.Solid  4.White blaze-collar-boots-chest

Type A_______  Type B_______  (Check One)               Natural Bob Tail (Yes or No)__________

Your Kennel Name_______________________________Reg. #(if known)_____________________

Toy under 10lbs_____Mini 10-18lbs_____Standard 18-28lbs______Decker  22-40lbs________

Owners Signature___________________________________________
Please attach any known pedigree/history information.

_______________________________________________________________________________

_______________________________________________________________________________
.
Dogs Name___________________________Height______Weight_______Color___________
.
General Condition of Dog________________________________________________________

_____________________________________________________________________________
.
Does the dog have any of the following diseases:
.
Demodectic Mange ____Yes____No
Retinal Atrophy____Yes____No
Epilepsy  ____Yes____No
Patellar Luxation____Yes____No
Major Allergies ____Yes____No
.
Does the dog appear to be in good condition____Yes____No
.
Veterinarian's Comments:_____________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________
.
I find this dog to be an acceptable specimen of the Rat Terrier breed.
.Name of Vet Clinic______________________________________
.
Veterinarians Name_________________________License #____________________________
.
Veterinarians Signature______________________Phone Number________________________