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EJRTCA Veterinarian Certificate
English Jack Russell Terrier Club Alliance, Inc.
An Official Club for the Short-Legged Jack Russell Terrier
14405 Highway 98, Magnolia AR 71753
Phone: (318) 286-7151    Email:
ejrtlady@gmail.com

    Terrier's Name: ___________________________________________________ Age: ____________

    Owner's Name: ____________________________________________________________________

    Address: _________________________________________________________________________

    City: ________________________________________ State: _______ Postal Code: ____________

    Phone Number: ___________________________ EJRTCA Membership # ____________________

    1. Chest Measurement: ______ inches: (at deepest part of the chest behind front legs)
    2. Height at point of withers: __________ inches.
    3. Length of back: ________ inches (measured from base of tail to point of withers)
    4. Coat:   []Smooth      []Rough      []Broken
    5. Teeth:   []Scissors Bite   []Level Bite   []Undershot   []Overshot   []Other (describe)
    _________________________________________________________________________________
    6. Eyes:   []Normal   []No (describe) __________________________________________________
    Vision:   []Normal   []No (describe) ___________________________________________________
    Iris:   []Brown   []Blue   []Yellow   []Other ______________________________________________
    7. Cardiovascular:   []Normal   []No (describe) _________________________________________
    8. Testicles:   []Normal   []No (describe) ______________________________________________
    9. Hernia:   []No   []Umbilical   []Iguinal   []Other (describe) ______ _______________________
    10. Legs:  []Normal   []Sub-luxating Patella   []Luxating Patella, Grade _______  Other  _______   
    (describe)________________________________________________________________________
    11. Feet: (all four toes touching the ground?)   []Normal   []No (describe)  _________________
    12. Surgical Scars (describe): _______________________________________________________
    13. Temperament (toward a non-threatening person):   []Shy   []Normal   []Aggressive
    14. Veterinarian's general opinion: Are there any reasons why this terrier cannot
    function as a working dog or be used on the EJRTCA breeding program?

    _________________________________________________________________________________

    _________________________________________________________________________________

    Veterinarian's Signature: ____________________________________ Date: _________________

    Address: _________________________________________________________________________

    Phone: ___________________________________________________________________________

    © English Jack Russell Terrier Club Alliance, Inc.