SCWT Database Dog Submission Form

Type in data then click the "Submit Data" button to send the information to SCWTDB.org.
Submitter Info(required)
Name:
Address:  (Use for additional foreign address info)
City: 
State / Prov:  Postal Code: 
Phone:  Country: 
Email: 
If Submitter is not Owner or Breeder, please explain:
  If this is an update to a dog already in the SCWT Database, click the checkbox here, enter the dog's
registered name and then enter only the data to be added or changed, including owner and breeder info.
Owner InfoCheck to use Submitter Info:
Name: 
Address: 
City: 
State / Prov:  Postal Code: 
Phone:  Country: 
Email: 
Co-Owners (if any): 
Breeder/Litter Info(Please provide as much information as possible)   Check to use Submitter name & address:
Breeder Name: 
Address: 
City: 
State / Prov:  Postal Code: 
Phone:  Country: 
Email: 
Sire Registered Name: 
Sire Call Name:  Sire Reg #: 
Dam Registered Name: 
Dam Call Name:  Dam Reg #: 
Litter Whelp Date: Year: Month: Day:   
Dog Info
SCWTDB Dog ID:  (optional but helpful)
Registered Name: 
Call Name: 
Registration #:  Registry: 
Registration #2:  Registry 2: 
Ltd Registration:  Sex: 
DNA Registration #:   
Frozen Semen Avail:  Available At Stud:  What's This?
Spayed/Neutered:  Tattoo: 
Tattoo Description:  Tattoo Location: 
Microchip:  Chip Location: 
Chip Number:  Chip Registry: 
Dog Height:  Dog Weight: 
Eye Color:  Bite: 
Dropped Lower Incisors:  Puppy Coat: 
Health Info
It is our goal to show all health data as diagnosed. In order to do this, we will need a copy of the vet or pathologists report. This can be scanned and emailed, or faxed, or snail mailed. Please contact the SCWT Database Manager at comments@SCWTDB.org in order to do so. Thank you in advance for taking the time to do this.
Health Information:
Deceased:  Date of Death: 
Cause of Death:  Please help!
Veterinarian:     (please include address info if possible)
Tests/Certifications
All tests and certifications must be verifiable. If they are not already on the OFA or CERF website, please arrange with the Database Manager to provide a copy. See the information above in the Health section of this submission form.
Date:  Type:  Evaluated By:  Results or Cert #: 
DNA/Research
This allows you to list any DNA submissions from this dog to DNA Banks or to specific research projects.
Please put any additional comments or information in the Comments area below.
Date:  Submitted To:  Blood:  Cheek Swab:  Tumor:  Other: 
Other
Titles Earned:
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 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 diseases, health or temperament conditions 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.