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Dog Breeder Registration Form
Registration Year:
2025
Organization Information
*
Primary Owner/Applicant Full Name:
Field is required
Additional Owner(s) Name(s) (if applicable):
If any breeding dogs are co-owned, list all co-owners.
Business Name (if applicable):
*
Mailing Address:
Field is required
Field is required
,
--Select--
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Field is required
Field is required
Breeding Facility Address (if different):
,
--Select--
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
*
Phone:
Field is required
*
Email:
Field is required
Email is not in the correct format of abc@email.com
*
Preferred Contact Method:
Phone
Email
Mail
Field is required
Registration Type
*
Type of Breeder:
Hobby (<3 litters of puppies annually)
Commercial (3 or more litters of puppies annually)
Field is required
*
Are you a member of any dog breed clubs or registries?
If yes, please list:
Yes
No
Field is required
Field is required
Breeding Information
*
Number of breeding dogs (Males):
Field is required
*
Number of breeding dogs (Females):
Field is required
*
Estimated Number of Puppies Sold Annually:
Field is required
*
List all dog breeds currently part of your breeding operation:
Field is required
Animal Care & Facility Info
*
Housing Location:
Home
Kennel
Both
Field is required
*
Do you have a veterinary care plan for your breeding operation?:
Yes
No
Field is required
*
At what age do you allow puppies to go into their new homes? (in weeks):
Field is required
*
Do your puppies receive vaccines and deworming before placing in a new home?:
Yes
No
Field is required
*
Do you offer a health guarantee?:
Yes
No
Field is required
*
Do you offer a return-to-breeder policy if the dog can't be kept?:
Yes
No
Field is required
Veterinarian's Name and Practice:
Required Document Uploads
The following documents are required:
Proof of rabies vaccine for all owned dogs over 3 months of age (required by ordinance)
Photos of the area your breeding dog(s) are primarily housed
Veterinary Care Plan (required by ordinance)
Dog Socialization and Enrichment Plan (required by ordinance)
*
Select File(s) to Upload:
No file selected
Only .pdf, .jpg, and .png files are allowed
Acknowledgment & Signature
Acknowledgment: I certify that the information provided in this registration form is true and complete to the best of my knowledge. I further agree to comply with all applicable local, state, and federal laws and regulations pertaining to the breeding, care, and sale of dogs.
*
Electronic Signature (Type Full Name):
Field is required