BEAGLE EPILEPSY RESEARCH PROJECT
Litter Information

(Attach Pedigree, and Litter List) Litter ID Code:______________________

Breeder(s):_______________________________________ Litter birthdate:_______________________

Information Contact: (Name) _____________________________________________________________________

(Street, City, State, Zip)__________________________________________________________________________

(Phone – Day) (       )_____________ (Phone – Eve) (____)__________________

(Fax) (___)_____________________ (Email) _____________________________

Age of parents at breeding: Sire:__________ Dam:___________

This litter resulted from (circle all that apply):

Natural breeding        Artificial Insemination        Surgical Insemination         Chilled semen         Frozen semen

Number of pups:

• At birth:Live                                     M____F____     Dead        M___F___

• Surviving at 6 weeks:                     M____F____

• Surviving at 1 year                         M____F____

• Surviving at submission date      M____F____

Known health problems in litter (list problem, dog name & Litter ID Code form Litter List, age of onset of problem, and pertinent details). Please attach additional sheets if necessary.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Other litter notes or comments, attach additional sheets if necessary.