Online Single Dog Registration – United Canine Association

This form is intended for registration of Non-UCA registered dogs or dual registration purposes only. If original United Canine Association paperwork has been issued, it must be mailed to the UCA Office accompanied by the payment and required photos. Thank you.

Breed of Dog:

Name of Dog to be Registered: *

Please limit name to 25 characters.

Bloodline (if desired):

Date of Birth: *

Sex: *

Male
Female

Color / Markings: *

Microchip Number / Tattoo:

Pedigree Information:

Required to complete the registration process.

Name of Sire (Father):

Sire's Registration Number:

Breed of Sire:

Name of Dam (Mother):

Dam's Registration Number:

Breed of Dam:

Copy of Pedigree: *

Click or drag a file to this area to upload.

All Single Dog Applications MUST be accompanied by at least 3 generations of pedigree information and a copy of the dog's registration certificate that shows ownership.

Copy of Certificate: *

Click or drag a file to this area to upload.

All Single Dog Applications MUST be accompanied by at least 3 generations of pedigree information and a copy of the dog's registration certificate that shows ownership.

Breeder's Information:

Name of Breeder:

First

Last

Breeder's Phone Number:

Breeder's Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Owner's Information:

Name of Owner: *

First

Last

Name of Co-Owner: (optional)

First

Last

Co-Owner - Type of ownership (optional)

Please select one of the following: "and" requires both owner's signatures, "or" requires either signature.

Owner's Phone Number: *

Co-Owner's Phone Number:

Owner's Email:

Confirm Email

Owner's Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Photos:

3 photos (2 profile shots & 1 frontal head shot) must accompany this application.

#1 Photo - Front: *

Click or drag a file to this area to upload.

#2 Photo - Left: *

Click or drag a file to this area to upload.

#3 Photo - Right: *

Click or drag a file to this area to upload.

#4 Photo - Optional:

Click or drag a file to this area to upload.

Comments

Registration Options:

Registration Choices:

New UCA Registration - Includes Certified Registration Certificate.....$30
New UCA Registration with Photo - Includes Certified Registration Certificate with photo......$45
Laminate UCA Registration Certificate (plus registration fee)......$8

Pedigree Choices:

3 Generation Pedigree....$30
4 Generation Pedigree....$40
5 Generation Pedigree....$50
3 Generation Pedigree w/ Photo Insert (please provide photo)......$40
4 Generation Pedigree w/ Photo Insert (please provide photo)......$50
5 Generation Pedigree w/ Photo Insert (please provide photo)......$60
Laminate Pedigree (plus pedigree fee)......$8

Additional Choices:

UCA Auto Window Decal......$10
Pet Photo Identification Card......$12
Conformation Show Entry Card.....$12

Processing and Mailing Options:

Standard Processing......$0
RUSH Processing - (5 business days)......$15
SUPER RUSH Processing (3 business days)......$20
Standard Mailing......$0
Overseas/Canadian Mailing......$5

Total

$ 0.00

Debit / Credit Card For Payment

Select Type of Card

Name on the Debit / Credit Card: *

First

Last

Credit Card Number: *

Expiration Date: *

Card Verification Code (CVC): *

3 digits on the back of the card

I do hereby certify that I am the true owner of the dog described above and that all of the information provided by me on this application is correct to the best of my knowledge and belief.

Please Sign Above.

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