United Doberman Club National 2010
Presents
All Breed Health Clinic on April 30, 2010
(9am-12pm)TBD
Echocardiogram 24-hour
Holter Hips Elbows
Thyroid VWD CERF
The Eyes are the Window to the Soul
(CERF requires 50 dogs, will be canceled if this number
is not reached.)
Echocardiogram and 24 Hour Holter and BNP
Available with Dr. Nancy Morris, DVM DACVIM www.massvetcardiology.com
Hips, Elbows, Thyroid and Wellness
Available with Dr. Edie DeMaria, VMD www.petsaloudnj.com
CERF
Available with Dr. Marjorie Neaderland www.animaleyeclinic.net
OFA paperwork can be found at www.ofa.org/applications
OFA requires a separate check. CHIC dogs do not need
additional fee for repeat OFA
VWD information can be found at www.dpca.org
Pre-paid Registration by April 7, 2010
Please send all OFA forms, registration forms with
checks (payable to TSDC or OFA) to:
Pam Burns - 40 Waterford Avenue Latham, NY 12110
Any questions, contact Pam Burns at pamtotaldobe@aol.com or 518/250-4223 (www.2010udcnationals.com)Õ
Please fill out one form per dog
|
Dog's Name |
|
Call Name |
|
|
Registration
# |
|
Microchip
# |
DOB |
|
Breed |
|
Male or
Female |
Intact? |
|
Sire Name
& Reg. # |
|
|
|
|
Dam Name
& Reg. # |
|
|
|
|
Owner's
Name |
|
|
|
|
Co-Owner's
Name |
|
|
|
|
Owner's
Email |
|
|
|
|
Owner's
Phone |
|
|
|
|
Owner's
Address |
|
|
|
|
Owner's
Address |
|
|
|
|
Test |
Price |
DogÕs Name |
Total |
|
Echocardiogram |
$200.00 |
|
$ |
|
24 Hour
Holter |
$175.00 |
|
$ |
|
BNP Blood
Testing |
$100.00 |
|
$ |
|
Hips |
$150.00 |
|
$ |
|
Elbows |
$150.00 |
|
$ |
|
Hips and
Elbows |
$225.00 |
|
$ |
|
Thyroid |
$105.00 |
|
$ |
|
VWD |
$99.00 |
|
$ |
|
CERF |
$35.00 |
|
$ |
|
TOTAL
PAYMENT |
|
|
$ |
RELEASE AGREEMENT
I understand that this
event will be conducted pursuant to the rules and regulations of the United
Doberman Club (UDC). I agree to abide by those rules and regulations. I
understand that every dog at this event is required to be under the care and
control of its named owner or handler at all times. I understand and agree to
be fully responsible for the actions of the dog named above and for the actions
of any and all other dogs that I might bring to this event. I agree to
indemnify Tri-State Doberman Club, Inc, UDC and any other persons or entities
sponsoring or hosting this event for any loss or injury resulting from my
actions or the actions of my dog (s), either directly or
indirectly, to any person
or thing and to hold Tri-State Doberman Club, Inc, , UDC and any other sponsor
or host harmless for such loss or injury.
Signature of Owner or Authorized
Handler__________________________________________________ Date__________________________________