Owners Information ______________________________________________________________________ Owners Name                       Phone #: Home           Alt. ______________________________________________________________________ Address                                  City                State       Zip Veterinarian Information ______________________________________________________________________ Clinic Name                   Veterinarian Name                  Veterinarian Phone Number ______________________________________________________________________ Address                                  City                State       Zip Dogs Information Please circle the breed of the dog registering for Tiny Breed status. Imperial Shih Tzu        Teacup Poodle        Sleeve Pekingese Teacup Chihuahua        Teacup Yorkshire Terrier ______________________________________________________________________ Dogs Name                  Sex                  Registration #                  Date of Birth ______________________________________________________________________ Microchip #(Required)                                                   Certified Weight This is to certify that the dog being examined is over one year of age, in good general health. The weight of the dog in question must be a natural size and with no reason to believe it may have stunted growth. ______________________________________________________________________ Owners Signature                                                             Date ______________________________________________________________________ Veterinarian Signature                                                        Date If these proper conditions apply, the dog in question may be registered as a Tiny Breed by NADSR. Please mail your request to: North American Dog Sports and Registry P.O. Box 1136 Pine Grove, LA 70453 Phone: 225-777-4146 Email: nadsr@nadsr.com Website: www.nadsr.com