ALAIFZ (1/10) 2010 The American Kennel Club

Use this application to register a litter of puppies, resulting from artificial insemination, that was inseminated and
whelped in the USA from an AKC

-registered female and the frozen semen of an AKC-registered male or an approved

Application to Register a Litter Resulting from
Artificial Insemination Using Frozen Semen
B
C
1
A
B

foreign male of the same breed. Important information and instructions are on page 3 of this form. Please use black ink and capital letters to fill in the boxes.
Registration is not guaranteed. Processing fees are nonrefundable and all fees are subject to change without notice.
Month
Date of Birth:
_ _
Breed:
Year Day
Litter Information
Semen Owners/Co-Owners Signature
AKC Number of Sire (Male) Registered Name of Sire (Male)
Sire (Male) Information: To Be Completed and Signed by an Owner/Co-Owner of Semen on Date of Insemination
I authorized shipment by of frozen semen collected from this stud to
Name of Storage Facility
Name and Address of Veterinarian
for the purpose of inseminating the bitch
AKC Registered Number and Name of the Dam
_ _
Semen Owners First Name Semen Owners Last Name
Telephone Number Email Address
I (we) AgRee ThAT Any CAUSe oF ACTIon, ConTRoveRSy oR CLAIm ARISIng oUT oF oR ReLATed To ThIS RegISTRATIon oR AS To The ConSTRUCTIon, InTeRPReTATIon And eFFeCT
oF ThIS AgReemenT ShALL Be SeTTLed By ARBITRATIon PURSUAnT To The APPLICABLe RULeS oF The AmeRICAn ARBITRATIon ASSoCIATIon. howeveR, PRIoR To ARBITRATIon ALL
APPLICABLe AKC ByLAwS, RULeS, RegULATIonS And PRoCedUReS mUST FIRST Be FoLLowed AS SeT FoRTh In The AKC ChARTeR And ByLAwS, RULeS, RegULATIonS, PUBLIShed
PoLICIeS And gUIdeLIneS.
Calculate this litters puppy fee:
Enter $35.00 if you want expedited handling. See page 3 for details.
Enter $65.00 if it has been more than 6 months since the litter was whelped.
Send the completed application to the address specified on page 3 of this form.
Processing Fee
Puppy Fee
expedited handling
Late Fee
$
$
$
$
$ Total Fee
3 0
number living: males females + = x $2.00
VISA AMEX Charge my:
Account Number (do not include dashes)
_
Printed Name of Cardholder Expiration Date
MasterCard Discover
Payment and Submittal Information See page 3 of this form for complete details
I (we) AgRee ThAT Any CAUSe oF ACTIon, ConTRoveRSy oR CLAIm ARISIng oUT oF oR ReLATed To ThIS RegISTRATIon oR AS To The ConSTRUCTIon, InTeRPReTATIon And eFFeCT
oF ThIS AgReemenT ShALL Be SeTTLed By ARBITRATIon PURSUAnT To The APPLICABLe RULeS oF The AmeRICAn ARBITRATIon ASSoCIATIon. howeveR, PRIoR To ARBITRATIon ALL
APPLICABLe AKC ByLAwS, RULeS, RegULATIonS And PRoCedUReS mUST FIRST Be FoLLowed AS SeT FoRTh In The AKC ChARTeR And ByLAwS, RULeS, RegULATIonS, PUBLIShed
PoLICIeS And gUIdeLIneS.
Dam (Female) Information: To Be Completed and Signed by All Owners or Lessees of Dam on Date of Birth
AKC Number of Dam (Female) Registered Name of Dam (Female)
I (we) certify that I (we) am (are) the owner(s)
or lessee(s) of the identified Dam and that on
Month
_ _
Year Day
I (we) delivered the bitch to
and authorized him/her to inseminate this bitch. I (we) certify that the Dam, while in my (our) possession, was not mated to or inseminated by any other dog during her season.
Veterinarian
AKC will send the litter kit (one registration application for each puppy) to the address below.
1st Owners First Name 1st Owners Last Name
Mailing Address
_
City ZIP code + 4 State
Telephone Number Email Address
_ _
I (we) witnessed this artificial mating:
Yes No
2nd Owners First Name 2nd Owners Last Name
2nd Owners Signature
1st Owners Signature
Check or Money Order made payable to: The American Kennel Club.
Provide your email address to receive important AKC communications.
AKC Number of Sire (Male) AKC Number of Dam (Female)
Sire and Dam Information Please reenter the registration numbers of the Sire and Dam from page 1
Application to Register a Litter Resulting from
B
C
2
A
B
AMERICAN KENNEL CLUB

Artificial Insemination Using Frozen Semen

To Be Completed Only If Ownership of Dam Changed or Lease Terminated while Dam Was in Whelp (Pregnant)
Owners First Name Owners Last Name
I (we) certify that I (we) was (were) the owner(s) or lessee(s) of the identified Dam on the date the Dam was inseminated with semen from the identified Sire. I (we) certify that the
Dam, while in my (our) possession, was not mated to or inseminated by any other dog during her season. I (we) AgRee ThAT Any CAUSe oF ACTIon, ConTRoveRSy oR CLAIm ARISIng
oUT oF oR ReLATed To ThIS RegISTRATIon oR AS To The ConSTRUCTIon, InTeRPReTATIon And eFFeCT oF ThIS AgReemenT ShALL Be SeTTLed By ARBITRATIon PURSUAnT To The
APPLICABLe RULeS oF The AmeRICAn ARBITRATIon ASSoCIATIon. howeveR, PRIoR To ARBITRATIon ALL APPLICABLe AKC ByLAwS, RULeS, RegULATIonS And PRoCedUReS mUST
FIRST Be FoLLowed AS SeT FoRTh In The AKC ChARTeR And ByLAwS, RULeS, RegULATIonS, PUBLIShed PoLICIeS And gUIdeLIneS.
Owners/Lessees Signature
Veterinarians Certifcation: To Be Completed and Signed by the Veterinarian
I affirm that the following breeding unit(s) was (were) sealed when presented
to me and that none of the semen was used to inseminate any other bitch.
Breeding Unit Number Month Year Day
Breeding Unit Number Month Year Day
Breeding Unit Number Month Year Day
Breeding Unit(s) Date Semen Collected
# Units Used
# Units Used
# Units Used
_ _
_ _
_ _
I certify that on I received frozen semen of the above named stud from:
Month
_ _
Year Day
_
City ZIP code + 4 State
Street Address of Storage Facility
Name of Storage Facility
I inseminated the bitch named above with said semen
on the following date(s):
Month
_ _
Year Day Month
_ _
Year Day
Veterinarians First Name Veterinarians Last Name Veterinarians Signature
Street Address
_
City ZIP code + 4 State
Telephone Number Veterinarians License No.
_ _
_
City ZIP code + 4 State
Street Address
Insemination was performed at the following address:
ALAIFZ (1/10) 2010 The American Kennel Club
General Information and Instructions
Application to Register a Litter Resulting from
B
C
3
A
B
AMERICAN KENNEL CLUB

Artificial Insemination Using Frozen Semen

Use this application to register a litter of puppies, resulting from artificial insemination, that was inseminated and
whelped in the USA from an AKC-registered female and the frozen semen of an AKC-registered male or an approved
foreign male of the same breed. AKC rules and regulations may be viewed on our Web site at: www.akc.org.
Purpose
mandatory
Requirements
for Frozen
Semen
The certifications on this application must be completed by the owner of the semen, the owner(s) or lessee(s)
of the dam, and the veterinarian who performed the artificial breeding.
3.
Breeding unit identification must include breed, AKC registration number of stud, date semen collected, and
number of breeding units used.
4.
The collector/storer must be familiar with and comply with the AKC regulations for record keeping and
identification of dogs (see page 4).
2.
1. After October 1, 1998, AKC DNA Profiling is required for all stud dogs whose semen is collected for frozen
semen use, including foreign stud dogs whose semen is collected and frozen to be imported for use in the
United States.
other
Artificial
Insemination
Litters
note: These forms are available on our Web site: www.akc.org
Fresh Semen: Submit an Application to Register a Litter Resulting from Artificial Insemination Using Fresh Semen.
Fresh extended Semen: Submit an Application to Register a Litter Resulting from Artificial Insemination Using
Fresh Extended Semen.
Standard handling
Send the completed application to:
The American Kennel Club
P.O. Box 900058
Raleigh, NC 27675-9058
mailing
Information
expedited handling
Send the completed application to:
The American Kennel Club
P.O. Box 900055
Raleigh, NC 27675-9055
Processing fees are nonrefundable and all fees are subject to change without notice.
A litter application fee always comprises two parts: a processing fee ($30.00) plus a puppy fee (multiply the number
of live puppies by $2.00).
Additional fees are determined by circumstance:
Expedited Handling ($35.00) Expedited Handling and Priority Mail service are available in the
Continental U.S. only. Allow 3-5 days for delivery.
Late fee ($65.00) Required if it has been more than 6 months since the litter was whelped.
AKC DNA Profile ($40.00) AKC DNA kits are available through our Web site or can be ordered by
email: dna@akc.org. Prepaid kits are available for $35.00.
note: If paying by check or money order, make payable to: The American Kennel Club
Fees
Signatures of persons other than the owners or lessees will be accepted only if a properly completed authorization
form has been filed with the AKC.
Authorizations
note: These forms are available on our Web site: www.akc.org
Email AKC at info@akc.org or call 919-233-9767 to speak to an AKC Customer Service Representative,
Monday Friday, 8:30 AM 5:00 PM. Information about the registration process and downloadable forms
are available on our Web site: www.akc.org.
Assistance
The American Kennel Club reserves the right to correct or cancel for cause the registration of this litter and
its descendants. Any misrepresentation on this application is one example of for cause cancellation and may
result in loss of AKC privileges. By supplying your email address and/or telephone number, you consent to
receive communications from AKC and third parties. Registration is not guaranteed. Processing fees are
nonrefundable and all fees are subject to change without notice. Once submitted, this application becomes
the property of the American Kennel Club.
notice
If there are more than two (2) Dam owners or lessees, contact the AKC for an Additional Signature Form.
If a Dam was leased at the time of mating or birth of a litter, you must submit a Lease Notification form.
Import DNA requirement: All imported dogs (male or female) registered on or after March 1, 2006 require
AKC DNA profiling prior to the registration of their first AKC-registered litter.
Additional
Requirements
note: These forms are available on our Web site: www.akc.org
These Regulations shall supplement the Regulations for Record Keeping and Identification of Dogs.
REGULATIONS APPLYING TO THE REGISTRATION OF LITTERS PRODUCED
THROUGH ARTIFICIAL INSEMINATION USING FROZEN SEMEN
Each person engaged in the collection, freezing, storage, shipping and insemination of frozen semen shall follow such practices and maintain
such records as will preclude any possibility of error in identification of any individual dog or doubt as to the parentage of any dog or litter.
VI TRANSFER OF OWNERSHIP OF SEMEN:
Records required to be kept by owners of dogs from which semen has been
collected and stored, and records required to be kept by collector (if semen
is held in storage) must also note transfers of ownership of semen. Such
records to include:
Authorization of transfer
Number of breeding units transferred
Date of transfer
Name and address of new owner
The AKC shall be immediately notified of such transfer of ownership of
frozen semen.
VII LOCATION OF STORED SEMEN:
In the event semen is stored at a facility other than the facility at which it
was collected, frozen and initially storedorin the event all or part of the
collected frozen semen is transferred to a new owner (see Sections ll and Vl
above), the owner or new owner shall immediately notify AKC. Such notifica-
tion shall include:
Identification of semen (Breed, AKC registered name and number
of stud dog, date semen collected)
Number of breeding units relocated
Date transferred to new storage facility
Name and address of storage facility
VIII CERTIFICATION:
The AKC shall require such certifications from the semen owner, owner (or
lessee) of bitch, and veterinarian who inseminated bitch, as shall be neces-
sary to support an application for registration of a litter of dogs produced by
the use of frozen semen.
IX INSPECTION:
The rules provide that the AKC or its duly authorized representatives shall
have the right to inspect the records required to be kept and the practices
required to be followed by these regulations and to examine any dog regis-
tered or to be registered with the AKC.
X PENALTIES:
The rules provide that the AKC may refuse to register any dog or litter or
to record the transfer of any dog, for the sole reason that the application is
not supported by the records required by these regulations. The rules also
provide that the Board of Directors of the AKC may suspend from all privi-
leges of the AKC any person who fails to observe the above regulations.
d. Collector shall also maintain records of all transfers of
ownership of stored semen. (See Section Vl below re: transfer of
ownershlp of semen.)
IV RECORDS TO BE KEPT BY BREEDERS:
In addition to the records required to be kept by owners and
breeders, as provided in AKCs pamphlet Regulations for Record
Keeping and Identification of Dogs, owners (or lessees) of bitches
inseminated shall include the following:
Name and address of veterinarian who handled insemination
AKC registered name and number of bitch inseminated
Date(s) of insemination
Identification of semen (Breed, AKC registered name and number of
stud dog, date semen collected)
B. Collector/Semen Bank:
The AKC shall be immediately notified by the collector/semen bank
whenever semen is shipped for intended use. Such notification shall include
the identity of the stud dog by its breed; registered name and number; the
number of breeding units shipped; the identification of such breeding units;
the name and address of the person to whom the units were shipped; and
the date of shipment.
A. Collector:
Cheek swab DNA sample must be obtained by the collector, submitted with
the notification of collection to AKC, and result in a DNA Profile and Number
issued by AKC (unless an AKC DNA Profile is already on record). The AKC
shall be immediately notified by collector of collection and freezing of canine
semen. Such notification shall identify stud dog by its breed; AKC registered
name and number; the number of breeding units collected; date stored;
address of storage facility; name and address of owner of stud dog.
A. dog Identification:
Breed
AKC registered name and number of stud dog
Sex, color, markings of stud dog (include tattoo, if any)
Color photographs of stud dog (full front and full side views)
Date of birth
AKC registered name and number of sire and dam
Name and address of owner of stud dog
(AKC suggests that collector also keep a health work-up of stud dog as
part of stud dogs identification)
B. Collection of Semen:
Date on which stud dog was received
Owners authorization of semen collection
Date semen collected, frozen and stored
Number of breeding units stored
Form of semen storage (Pellets, Ampules, Vials, Straws, etc.)
Container in which each breeding unit is stored shall be indelibly imprinted
to show: Breed, AKC registration number of stud dog, Date semen collected
C. disposition of Semen:
Identification of shipped semen
Number of breeding units shipped
Name and address of person to whom semen shipped
Authorization of semen owner for shipment
Date(s) semen shipped
III RECORDS TO BE KEPT BY OWNERS OF SEMEN OF STUD DOGS
WHEN BREEDING HAS BEEN ARRANGED:
Identification of semen (Breed, AKC registered name and number of
stud dog, date semen collected)
Number of breeding units authorized for shipment and insemination
Date of shipment
To whom semen shipped
AKC registered name and number of bitch to be inseminated
Name and address of owner of bitch
AKC registered name and number of stud dog
Date dog shipped to collector
Name and address of collector
Number of breeding units collected, frozen and in storage
Location of semen storage
Transfer of ownership of semen (see Section Vl below)
II RECORDS TO BE KEPT BY OWNERS OF STUD DOGS:
In addition to the records required to be kept by owners and breeders, as
provided in AKC pamphlet Regulations for Record Keeping and Identifica-
tion of Dogs, owners of dogs from which semen has been collected, frozen
and stored, shall include the following:
V NOTIFICATION TO AKC BY COLLECTOR: I RECORDS TO BE KEPT BY COLLECTOR:
RECORDS:
To provide a source of reference for the registration of litters of purebred dogs produced by artificial insemination, using frozen semen,
applications for which have been made, or may later be made, to the American Kennel Club, and to assure the accuracy of such applications,
certain minimum records must be kept.
All required records shall be made immediately, when dog has been delivered for the purpose of semen collection, at time of shipment of frozen
semen, and insemination of same; shall be kept on forms devoted to that exclusive purpose; and shall be consecutive, accurate and up-to-date.
Such records shall be maintained for a period of no less than five years from the point in time when the last of the frozen semen from a given
stud dog is used.
Application to Register a Litter Resulting from
B
C
4
A
B
AMERICAN KENNEL CLUB

Artificial Insemination Using Frozen Semen