ALASKAN KLEE KAI KENNELETTE
14845 W. CHAPARRAL LOOP
PEYTON, COLORADO 80831
ALASKAN KLEE KAI EXAMINATION AND EVALUATION FORM
Note: This examination form is to be completed by a Veterinarian after Subject dog is Eight Months old and preferably before he is one year old. This form is to be completed, and returned to the above address along with three pictures of the animal. One full standing view from the front - one full standing view from the side, and one full standing view from top. After receipt, the data on the form will be recorded on the Alaskan Klee Kai Kennelette History of Records and will be available for recording On the Alaskan Klee Kai Association of America, Inc. Records.
Alaskan Klee Kai Kennelette Owners or Agents will use this form and the attached pictures to determine the quality of the subject animal. Determination will be based on the information submitted and will be according to the Alaskan Klee Kai Breed Standards, and according to any medical or structural information submitted. Any Alaskan Klee Kai that carries serious faults or disqualifications, or medical or structural faults that are considered to be genetic in nature, is subject to being disqualified from the Alaskan Klee Kai Kennelette Breeding program and required to be neutered or spayed.
=====================================================================
OWNER IS TO COMPLETE ALL SPACES IN THIS SECTION
FULL REGISTERED NAME OF DOG ________________________________
Date of Birth ________________
SIRE _______________________ DAM _________________________
MICROCHIP # __________________________ UKC # _______________
Name(s) of owner(s) (print) _________________________________________
Address: ____________________________________________________________
(street – city – state – zip)
Home Phone number _________________ work phone number ________________
E-Mail address (print clearly) ______________________________________
OWNER’S SIGNATURE ___________________________________________________
=======================================================================
TO THE VETERINARIAN
We appreciate your assistance in helping us document important information by carefully completing this questionnaire.
1. Please circle closest color: (grey & white) (black white) (red & white) (white)
2. Are all markings symmetrical? (yes) (no)
Please describe non-symmetrical markings on the back of this form.
3. Does the dog have a distinctive mask that is visible due to contrasting colors? (yes) (no)
4. Is there a dark strip on the muzzle so wide that it extends down the sides of the muzzle? (yes) (no)
5. Is there darker color directly under the eyes? (yes) (no)
6. Is there darker color under the eyes that is deeper than 1/2 the length of the muzzle? (yes) (no)
7. what is the color of the eyes? Right _______ Left ______
Are there tear stains? (yes) (no)
8. Are both ears strongly erect from base to tip? (yes) (no)
9. Is the tail long enough to curl up and touch the back? (yes) (no)
10. Please circle the best description of the bite:
A: lower teeth lie behind upper teeth and touch inside of upper teeth (scissors bite)
B: The tips of the lower teeth meet the tips of the upper teeth (straight bite)
C: The upper jaw extends forward so lower teeth cannot touch inside of upper teeth (overshot bite)
D: The lower jaw extends forward so the lower teeth are in front of the upper teeth (undershot bite)
E: Teeth are misaligned so none of the above apply (cross bite)
11. What is the dog's weight? _________
12. What is the dog's height from floor to top of front shoulders? ______________
13. What is the length of back from front of shoulder blades to base of tail? ______________
14. What is the dog's temperament? (friendly) (cautious) (extremely shy) (aggressive)
15. Are both testicles in the scrotal sac? (yes) (no) (not applicable)
16. has this dog been spayed or neutered? (yes) (no)
16a. If this is a neutered male dog - were both testicles in the scrotal sac at the time of neuter? (yes) (no) (unknown)
17. Please circle any of the following physical or structural problems that you detect:
(heart murmur) (Patellar Luxation) (Cataracts) NOTE:if any apply please explain on the back
18. Please list any other physical or structural problems you detect.
_________________________________________________________________ ______________________________________________________________
19. Please make explanatory comments for any of the above questions on the back of this form.
20. Liver Enzyme Test --- Count ______ on an average scale of ______ to _______.
VETERINARIAN'S SIGNATURE __________________________
DATE _________
Please attach business card, or print Veterinarians name, address and phone number
THANK YOU FOR HELPING US GATHER INFORMATION THAT WILL ASSIST IN KEEPING THIS A QUALITY CANINE BREED.