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| IGCC Breeders� Declaration of Clear Health |
| Italian Greyhound Club of Canada |
| Club Canadien du Petit Levrier Italien |
| Application to enter test results onto the IGCC Breeders� Resource Website DOG INFORMATION _________________________________ __________________ Dog's Registered Name Registration Number __________ _____________________ ___________________ Sex Color Date of Birth _________________________________ Permanent ID (DNA/Microchip/Tattoo) OWNER�S INFORMATION __________________________________ ___________________ Owner(s) Telephone Number __________________________________ ___________________ Mailing Address Email Address __________________________________ Province & Postal Code THIS APPLICATION MUST BE ACCOMPANIED BY: 1. A copy of the official test results for: - ophthalmological disorders - thyroid function - patellar function 2. a written statement from a veterinarian, stating that there has been no tooth loss or leg fracture, and 3. a pedigree I hereby certify that the information provided above is accurate. I hereby authorize release of this information into the public domain of the IGCC Breeders� Resource Website. I understand and acknowledge that anyone with Internet access can view these results. _____________________________ __________________________ Signature of Registered Owner Date |