SCWT Database Litter Submission Form

Type in data then click the "Submit Data" button to send the information to the SCWT Database.
   
Submitter Info (required)
Name: 
Address:  (Use for additional foreign address info)
City: 
State / Prov:  Postal Code: 
Country: Phone:
Email: 
If Submitter is not Breeder, please explain: 
 
If this is an update to a litter already in the SCWT Database, click the checkbox here, enter enough information to identify the specific litter, then enter the data to be added or changed.
Breeder Info   Check here to use Submitter name & address:
Breeder Name: 
Address:
City:
State / Prov: Postal Code: 
Country: Kennel Name: 
Email: Phone:
Litter Info
Litter Whelp Date: Year: Month: Day:   
Country of Birth: Litter Registration #:
Sire Registered Name:
Sire Call Name: Sire Registration #:
Dam Registered Name:
Dam Call Name: Dam Registration #:
Insemination Method:  Birth Method: 
Total Surviving Males:    (Alive at 8 weeks) Total Surviving Females:    (Alive at 8 weeks)
Stillborn Males:  Stillborn Females: 
Neonatal Death Males:  Neonatal Death Females: 
Note: We are using the term "Neonatal Death" to describe a puppy that was born alive but died before it was 8 weeks old. 
Puppy List
Puppy #1:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #2:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #3:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #4:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #5:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #6:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #7:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #8:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #9:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #10:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #11:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
 
Puppy #12:  Reg Name:  Call Name: 
  Reg Number:    AKC:  Sex: 
  Limited Reg: 
 
  Owner Name:  Owner Phone #: 
  Owner Address:   (private)
Additional Comments:
By clicking the "Submit Data" button below I am stating that the above data is correct and accurate to the best of my knowledge and that I voluntarily submit the above data for entry into the Soft Coated Wheaten Terrier Database. I authorize release of this data in accordance with the Soft Coated Wheaten Terrier Database policies, including affected phenotypes at the time I owned the dog(s) and I authorize a SCWTDB Operator to contact me for data validation purposes. I understand that phenotypes that were diagnosed after I relocated a dog must be verified with the current owner before being entered into the database.
Please direct any questions or comments about this form to comments@SCWTDB.org.