Southwest Welsh Springer Spaniel Club, Inc.

 

Membership Application & Sponsor Endorsement Form

Thank you for your interest in joining the Southwest Welsh Springer Spaniel Club. The Club expects all members to practice responsible dog breeding, ownership, advertising, sportsmanship and goodwill towards our breed as stated in the WSSCA Code of Ethics and the SWSSC Constitution and By-Laws.

 

Please print this form, fill it out, and forward it to your sponsor, along with your membership fee.

Questions? Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Type of Membership:

[ ] Member ------------------------------------------------------------------------------------------US $20.00

[ ] Family Membership ----------------------------------------------------------------------------US $30.00

[ ] Associate Membership (for applicants who reside outside CA AZ NV UT) -------------US $10.00

[ ] Junior Membership ---------------------------------------------------------------------------- US $0.00

[ ] Membership Emeritus ------------------------------------------------------------------------- US $0.00

 

Fees: Make checks (In U.S. Funds) payable to Southwest Welsh Springer Spaniel Club, Inc.

 

1. Primary Applicant’s Name: ________________________________________________________

2. Joint/Family Membership - - Additional Names: ________________________________________

3. Address: _______________________________________________________________________

4. City, State, Zip: _________________________________________________________________

5. Telephone: home ( ) ______________________ cell ( ) _________________________ work ( ) ________________________________

6. E-Mail Address: __________________________________________________

7. List Current Kennel Name or Prefix, and any others used previously: _______________________

_________________________________________________________________________________

 

8. What Hobbies &/or Skills do you have: _______________________________________________

9. Check here if you are a professional dog: [ ] Handler [ ] Groomer [ ] Trainer [ ] AKC Judge

10. Welsh Springer Spaniel ownership: [ ] Own [ ] Have owned [ ] Would like to own

11. When did you acquire your first Welsh Springer Spaniel? _______________________________

12. What other breed(s) of dogs have you owned? _______________________________________

13. Have you exhibited in:

[ ] Conformation - How Long ________ Titles Earned ________________________________________

[ ] Obedience - How Long ______ Titles Earned _____________________________________________

[ ] Field - How Long ________ Titles Earned _______________________________________________

[ ] Tracking - How Long ________ Titles Earned ____________________________________________

[ ] Agility - How Long ________ Titles Earned _______________________________________________

[ ] Rally - How Long ________ Titles Earned ________________________________________________

Other special dog activities: ____________________________________________________________

 

 

14. Do you plan to breed? [ ] Yes [ ] No [ ] Maybe

15. Have you Bred? [ ] Yes [ ] No, How many breedings? ________

16. Have you sold commercially? [ ] Yes [ ] No

17. Have you/your family ever been suspended by the AKC? [ ] Yes [ ] No

If yes, date and reason for suspension: ___________________________________________

18. List all dog clubs and animal organizations of which you are now, or previously have been, a

member:

Club Name Years of Membership Positions Held

____________________________ __________ ___________________________

____________________________ __________ ___________________________

____________________________ __________ ___________________________

 

19. Have you or a family member ever abandoned or turned in a dog to a shelter? [ ] Yes [ ] No

20. Have you or a family member ever had a dog picked up or taken by an animal control agency?

[ ] Yes [ ] No

21. Have you or a family member ever been convicted of animal cruelty, inhumane

treatment, or abandonment of an animal? [ ] Yes [ ] No

22. Do you know any other Welsh Springer Spaniel owners? [ ] Yes [ ] No If so, list them and how

long you have known them:_____________________________________________________

26. Why would you like to become a member of the SWSSC? _______________________________

_________________________________________________________________________________

 

Additional Comments:____________________________________________________ ______________________________________________________________________














Southwest Welsh Springer Spaniel Club, Inc.


Sponsor’s Endorsement

The Sponsor’s Endorsement should only be completed after the Membership Application portion has been completed by the applicant. Do not complete the Sponsor’s Endorsement in advance. Fill in all applicable areas completely as they apply to your knowledge of the applicant and their immediate family members. When completed forward the Membership/Sponsor’s Endorsement to the SWSSC Corresponding Secretary.

 

Sponsor’s name: ______________________________________________________

Address: ____________________________________________________________

City, State, ZIP: ______________________________________________________

Phone No: ( ) _____________________________________________________

E-Mail Address: _______________________________________________________

Applicant’s Name: _____________________________________________________

Phone No: ( ) _____________________________________________________

1. Are you personally acquainted with the applicant(s) [ ] Yes [ ] No

How long have you known them: _______________________________

2. Have you seen where they keep their dogs? [ ] Yes [ ] No

3. Do their dogs appear to be well-adjusted, happy and well cared for? [ ] Yes [ ] No

4. Has the applicant previously owned other dogs? [ ] Yes [ ] No

If yes, did you inquire what happened to the other dogs? [ ] Yes [ ] No

Were you satisfied with the answer? [ ] Yes [ ] No

5. Have you referred the applicant to local owners, trainers, etc.? [ ] Yes [ ] No

6. Has the applicant expressed an interest in becoming a breeder? [ ] Yes [ ] No

Breeding for profit? [ ] Yes [ ] No

7. Have you reviewed the application? [ ] Yes [ ] No

 

Any additional comments: ________________________________________________

 

I certify that I have reviewed the membership application and discussed it with the applicant. I have discussed genetic health problems such as hip dysplasia, epilepsy, and eye diseases with the applicant(s) and they are aware of the various clearances available. I find the responses acceptable and believe that the applicant understands responsible and ethical dog ownership and the objectives of the WSSCA. By my endorsement below, I recommend the applicant be accepted.


Signature: ___________________________________________ Date: ___________________