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Dog´s name incl. kennel name *

Variet *

Sex *

Date of birth *

Date of death

Stud book reg. No. *

Breeder´s name *

Owner´s name *

Street, No. *

City *

Postal code *

E-mail

Your address and e-mail will only serve for internal purposes and will not be published.

Which ear is affected *

Has the dog been examined by a BAER test? *

Any other information you can provide, e.g. how the deafness was diagnosed, if there are any examined ill or examined healthy close relatives, etc.

Your status *

Your e-mail *

Your phone No. *

Dog´s sire *

Dog´s dam *

Parents of dog´s sire:

Sire *

Dam *

Parents of dog´s dam:

Sire *

Dam*

Security Code: *
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