Page 1 of 2 – STUD SERVICE CERTIFICATE © Copyright CKCSC-USA Revised 8/10//2019

STUD SERVICE CERTIFICATE

REGISTERED NAME OF STUD: DATE OF BIRTH:

CKCSC (OR OTHER APPROVED) REGISTRATION #: TRANSFER # (if applicable): COLOR: T-

CHOOSE ONE OR MORE & GIVE #(s): MICROCHIP: TATTOO: DNA PROFILE:

NAME OF OWNER: NAME OF CO-OWNER:

STREET: STREET:

CITY: STATE: ZIP: CITY: STATE: ZIP:

PRIMARY PHONE: PRIMARY PHONE:

E-MAIL ADDRESS: E-MAIL ADDRESS:

REGISTERED NAME OF BITCH: DATE OF BIRTH:

CKCSC (OR OTHER APPROVED) REGISTRATION #: TRANSFER # (if applicable): COLOR: T-

CHOOSE ONE OR MORE & GIVE #(s): MICROCHIP: TATTOO: DNA PROFILE:

If the stud dog owner is responsible for this mating, complete below:

DATE 1: DATE 2: DATE 3: EXPECTED WHELPING DATE:

TYPE OF MATING: NATURAL AI AI using FRESH CHILLED SEMEN AI using FROZEN SEMEN

IS THIS BREEDING FOR A STUD FEE PUPPY? YES NO

NUMBER OF STUD FEE PUPPY(IES):

Owners of the stud dog and bitch should determine ahead of time what arrangement will be made should the bitch rear only one puppy and the breeding was effected for a stud fee puppy.

On the appropriate litter application, indicate any STUD FEE puppy(ies) by checking only the box(es) next to a Stud Fee Puppy’s name(s). Each of the undersigned: a) certifies, represents, and warrants to the Cavalier King Charles Spaniel Club, USA, Inc. (CKCSC-USA) that all the information in this application is valid (i.e., true,

accurate, complete, and not misleading); b) authorizes the CKCSC-USA to take such lawful steps as the CKCSC-USA, in its sole discretion, deems necessary or appropriate to investigate the validity or

invalidity of any such information; c) irrevocably agrees that if any of such information is found to be invalid and the breeder(s) knew or should have known it was invalid, s/he shall defend,

reimburse, indemnify, and hold the CKCSC-USA, and each of its Directors, employees, and other representatives harmless from any and all costs and expenses, including attorney fees, directly or indirectly caused by, resulting from or incurred in connection with such invalidity or investigation;

d) agrees that the CKCSC-USA, by accepting this Stud Service Certificate, shall be entitled to the full benefits of the provisions set forth in this paragraph, whether or not the CKCSC-USA ever issues registration for this litter.

I(we) hereby certify that I(we) authorized the breeding of the above-named stud dog to the above-named bitch.

SIGNATURE OF STUD DOG OWNER: DATE: SIGNATURE OF STUD DOG CO-OWNER: DATE:

I have included a SUPPLEMENTAL SIGNATURE FORM for ALL dogs with more than 2 owners.

(Please see page 2 of this form for additional pertinent information.)

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Page 2 of 2 – STUD SERVICE CERTIFICATE © Copyright CKCSC-USA Revised 8/10//2019

STUD SERVICE CERTIFICATE

READ BEFORE SENDING:

1. The owners of the Stud Dog and Brood Bitch should determine ahead of time the terms and/or fees for the required service, and what arrangement will be made if breeding was effected for a Stud Fee Puppy should the bitch rear one puppy only. Stud Fee Puppies should be selected prior to three (3) months of age to allow for timely registration. To avoid misunderstandings, specific terms and fees should be put in writing prior to any breeding taking place.

2. The Code of Ethics obliges all members resident in the USA to register every eligible Cavalier they breed

with the CKCSC-USA. 3. Only Cavaliers registered with or eligible for registration with CKCSC-USA at the time of mating, shall be

used for breeding. Any Cavalier duly registered with any CKCSC-USA Approved Foreign Registry, which includes the American Kennel Club (AKC), is eligible for registration with the CKCSC-USA.

4. For unregistered sires from an Approved Foreign Registry that are not obligated for registration with the

CKCSC-USA, litter application must include the following items: a) a clear, color copy of the Three-Generation Export or Certified Pedigree from the dog’s country of

origin; b) a clear, color copy of the Registration Certificate from the dog’s country of origin, showing transfer

of ownership to the applicant. 5. The CKCSC-USA will not register any dog which is sired by, or out of, a Cavalier owned or co-owned by any

person who is suspended, expelled or denied CKCSC-USA privileges where any breeding date is shown to be subsequent to the date of disciplinary action.

6. A Cavalier who has been restricted from breeding shall not be bred. Should it be bred, its get/produce will

not be eligible for registration with the CKCSC-USA and the member(s) will be subject to punitive action by the CKCSC-USA Board of Directors. Revocation of a breeding restriction must be RECORDED by the Registration Office before the mating takes place.

WARNING There shall be no agreement of terms of stud service, mating, registration of a litter, transfer, or terms of transfer of a dog, or any other CKCSC-USA procedure, which places the breeder, owner or any member in violation of the By-laws, the Code of Ethics or the Policies and Procedures of the CKCSC-USA. Lack of compliance with the above requirements may place the owner(s) of the sire and dam in violation of the Code of Ethics and this mating may result in puppies that are not eligible for registration with the CKCSC-USA.