VC/VCX Application – CSSA – Canadian Shetland Sheepdog Association

Dog Information

Dog's Registered Name (with titles)

CKC Registration Number

Sex Male Female

Birth Date

Breeder(s)

Sire (with titles)

Dam (with titles)

Color

Owner Information

Owner(s) Full Name

Mailing Address

City

Province / Territory

Postal Code

Phone

Email Address

Title Entry

Total: 0 pts

Qualifying categories (≥2 pts): 0

—

Conformation 0 pts

Agility 0 pts

Barn Hunt 0 pts

Obedience 0 pts

Rally 0 pts

Herding 0 pts

Scent Detection 0 pts

Tricks 0 pts

Tracking 0 pts

Chase Ability 0 pts

Sprinter 0 pts

Therapy Dog 0 pts

Scent Hurdle 0 pts

Draft Work 0 pts

Dock Diving 0 pts

Section A — Additional 1pt titles (max 1pt total)
Only if the dog holds no higher title in the same sport. CGN PCD CDI SDIN RATI

Section B — Dual Champion CKC DCH (3 pts)

Review & Submit

Point Summary

Sport	Title Selected	Points
Total		0

I am applying for:

Supporting Documents

Upload title certificates for each sport selected above. PDF, JPG, or PNG — max 10\u00a0MB per file.

Additional notes or information (optional)

Declaration

I consent to the collection of this personal information under the Privacy Act for the purposes of administering the CSSA Award programs.

I declare that the information provided in this application is accurate and complete to the best of my knowledge.

Electronic Signature (type your full name)

Date June 21, 2026

National Parent Club of the Shetland Sheepdog in Canada

VC /VCX/VCCH Application