13 Club Form

THE THIRTEEN CLUB NOMINATION & SURVEY INFORMATION The Thirteen Club collects information from owners of German Shepherds that are twelve years of age or older. Any German Shepherd Dog is eligible when they turn twelve years old, qualifying dogs nominated by their owners with the required information will receive a certificate of recognition. Materials and information submitted become the property of the GSDCA, Inc. ONLY DOGS LIVING JAN. 1ST OF THE CURRENT YEAR ARE ELIGIBLE.

SEND TO

NOMINATION PROCESSING REQUIREMENTS FOUR GENERATION PEDIGREE COPY OF AKC REGISTRATION COMPLETED SURVEY FORM OWNER'S NAME

Carolyn Putnam email: [email protected] 2436 Mountain View Drive Escondido CA 92027 ADDRESS

EMAIL ADDRESS CITY, STATE, ZIP

PHONE NUMBER DOG’S NAME WITH ALL TITLES

AKC NUMBER

DATE OF BIRTH

SEX CAREER (Circle all that apply)

CONFORMATION

AGILITY

BREEDING

F

SPAY OR NEUTER?

OBEDIENCE

HERDING

M

SCHUTZHUND

AT WHAT AGE?

NUMBER OF LITTERS SIRED OR WHELPED

SERVICE

NUMBER OF LITTERMATES STILL LIVING

PET

HIPS OFA?

OFA NUMBER

ELBOWS OFA?

OFA NUMBER

HIPS OCA?

OCA NUMBER

ELBOW OCA?

OCA NUMBER

SIGNS OF ANY SPINAL DISEASE?

IS THIS DOG LIVING?

AGE SPINE X-RAYED

IF NOT, GIVE DATE OF DEATH

AGE OF ONSET

CAUSE OF DEATH

YES

NO

FEEDING: HOW MANY TIMES PER DAY DO YOU FEED? ONCE

WHAT IS YOUR DOG FED? KIBBLE

CANNED

DO YOU ADD ANY SUPPLEMENTS? VIT. A

TWICE

RAW

VIT. E

VIT. C

THREE

COOKED

MINERALS

SOAKED

DRY

GLUCOSAMINE

CHRONDROITIN

HAS THE DOG’S DIET CHANGED?

IF SO, PLEASE EXPLAIN

HOUSING: HOW IS THE DOG KEPT?

AS A HOUSE DOG

IN THE KENNEL

COMBINED AS NEEDED

HEALTH: HOW OFTEN DOES THE DOG RECEIVE A VET EXAM? AS NEEDED

ONCE A YEAR

DO YOU GIVE YOUR DOGS ANY REGULAR MEDICATIONS? YES

NO

MORE OFTEN

IF SO, PLEASE LIST

HAS THE DOG HAD ANY SURGERY IN HIS LIFETIME?

HAS THE DOG HAD ANY MAJOR ILLNESS?

ANY ADDITIONAL COMMENTS?

SIGNATURE_______________________________________________

ARE YOU A GSDCA/GSDCC MEMBER? YES

NO