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Application for DNA Profiling

SEE BACK OF THIS FORM FOR COMPLETE RULES GOVERNING DNA PROFILING. Please carefully complete this form. UKC

is not responsible for errors caused by illegible handwriting. Incomplete applications may result in processing delays.

?DNA PROFILE ? $45 ?Frozen Semen ? $100 ?DNA Certification ? $15 ?DNA Transfer of

Ownership

? $15 ?Duplicate Certificate of DNA Analysis ? $15 ?DNA-VIP Upgrade ? $10

Establishes and records your dog"s unique DNA identification with UKC and UC Davis VGL, as well as provide you

with a Certificate of DNA Analysis. Do not send semen sample to UKC. Please contact UKC for more information.

For a dog that has been profiled by UC Davis VGL but not through UKC. This procedure puts DNA on UKC records.

Copy of DNA Certificate of Analysis is required.

Allows new owners to transfer ownership of the DNA profile from UC Davis and receive a new Certificate of DNA

Analysis in their name.

A Duplicate Certificate of DNA A

nalysis may be requested by the registered owner (as recorded by UKC) if the original has been lost, stolen or destroyed.

Dog is automatically upgraded to verify identified parentage (DNA-VIP) when dog"s sire and dam have been profiled,

compared and verified. For a DNA-VIP Certificate of Analysis, choose this option. Note: Both parents must be

DNA-Profiled with UC Davis VGL for pups to obtain DNA-VIP status.? Check ? Money Order ? Credit Card (Major Credit Cards Accepted) Nam

e of Cardholder __________________________________________________ Signature ________________________________________

Cardholder"s Complete Address _________________________________________________________________________________________

Credit Card Number _______________________________________________________________ Expiration Date ______________________

Please make your check or money order payable to: United Kennel Club • All payments must be in U.S. Dollars. Please no cash.

United Kennel Club • DNA Department • 100 E Kilgore Rd, Kalamazoo MI 49002-5584 • Phone: (269) 343-9020 • www.ukcdogs.comUKC Registered Name ________________________________________________________________________________________________________________

Breed _____________________________________________________Date of Birth _________________________________________________

UKC Number ______________________________________________Sex ? Male ?Female Color _______________________________

Sire"s UKC Number ________________________________________Dam"s UKC Number __________________________________________

Other Registry Name Other Registration Numbers

___________________________________________________________ _____________________________________________________________Name of Sole Signatory/Registered Owner (please print) ___________________________________________________________________

Current Address _______________________________________________________________________________________________________

City, State, Postal Code, Country ________________________________________________________________________________________

Phone Number ________________________________Email __________________________________________________________________

By signing this application I agree that the information provided on this form is true and correct. I understand that the sample I

have submitted may be archived for future analysis. I attest that I have read and understand the rules governing DNA Profiling on

the reverse side of this form.

Sole Signatory/Registered Owner Signature____________________________________________________Date__________________*All applications must be signed and dated by the Sole Signatory/Registered Owner (as recorded by UKC) of the dog submitted. Unsigned applications will not be processed.

Test results will only be mailed to the Sole Signatory/Registered Owner. Please allow 6-8 weeks for delivery.

See reverse side for additional Rules Governing DNA Profiling and Certification.FO25ADM/Rev. 12-16STEP 5: Select Method of Payment

For Office Use Only:Date Processed By Total Charges Authorization #

STEP 1: Select DNA Type

STEP 2: Dog Information (Incomplete or inaccurate information may result in processing delays)

STEP 3: Sole Signatory/Registered Owner InformationSTEP 4: Sole Signatory/Registered Owner Signature*

(UKC is not responsible for undeliverable mail due to incomplete mailing addresses)

CityState Postal Code

Rules Governing DNA Profiling

• Registration applications or certificates submitted with DNA requests will not be held for DNA results unless a signed statement by the Sole Signatory/Registered Owner (as recorded by UKC) is received with specific instructions to hold paperwork for results. • UKC registered dogs can only be DNA Profiled by the Sole Signatory/Registered

Owner (as recorded by UKC).

• All DNA information is considered confidential and will only be released to the Sole Signatory/Registered Owner (as recorded by UKC). • UKC registered dogs must be permanently registered at the time the DNA sample is submitted or before. • United Kennel Club"s DNA program allows dogs that are not registered with UKC to be DNA Profiled. However, it must be understood that DNA Profiling your dog will not make it eligible for UKC Registration. • United Kennel Club reserves the right to correct, withhold or revoke any UKC Registration Certificate or Pedigree resulting from a DNA Exclusion. • United Kennel Club reserves the right to require any dog, or dogs, to be DNA profiled pursuant to the maintenance of the integrity of UKC records at the cost of the registered owner. An owner who refuses to consent to DNA Profiling a dog over which he/she is the Sole Signatory/Registrant may face disciplinary action. • Dual-Sired Litters are eligible for UKC Registration once both of the potential Sires, the Dam, and all the pups have been DNA Profiled and the parentage has been verified through UC Davis VGL. The Sire and Dam of the litter must be permanently registered with UKC and eligible to register offspring with UKC. • Please contact UKC prior to submitting sample to lab. Frozen semen needs to be submitted at the time of artificial insemination. Please complete the following steps: •Save a small bit of semen in the straw at the time of artificial insemination.

•Place the straw in a re-sealable plastic bag. On the outside of the bag indicate the dog"s UKC number, name and that it contains semen.

•Ship the bag overnight to: Veterinary Genetics Laboratory, University of California, Old Davis Road, Davis, CA 95616. Please indicate on the outside of the envelope that it contains semen.

•You will need to complete an Application for DNA Profiling for your dog and submit it to the UKC along with the processing fee of $100. Please indicate on your application that semen was shipped directly to VGL.

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