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Dogs in Leave this field blank Coordinator Details (optional) Welfare Co-ordinator Choose Liz Bradley Karen Clayton Shirley Evans Penny Gutridge Karl Hahm Tony and Caroline Hart Jean Hill Linda Kennerley Margaret Mabon Cath Marchbank Sarah Masters Rob McLeod Nick Sanders Gill Paul Simms Magda Teale Pat Smith Fiona Ward Helen Bailey Kirsten Ritchie Area Representative Choose N/A Hazel Balding Michelle Bassett Karen Brandon Kevin & Jane Bunce Alan & Margaret Clapham Karen Clayton Mr & Mrs Coulson Arlene Forman Julian & Rosemary Gostling Jaqueline & Bernie Greef Anne Green Jean Hahm Jane Hannah Alison Huckle Peter & Linda Humphreys Mr & Mrs Jeffries Rod Jones Alan Leightell Cath Marchbank Sheila Maw Susan Meek Chris & Ann Mills Heather Payne Jacki Pilling Isla Reid Carol Rutherford Sandra Simpson Pat Smith Jim Talbot Janet & Bob Tolley Fiona Ward Jenny & Martin Watson Fiona Walton Mr & Mrs Waring Mr & Mrs Wells Jean Hill Helen Bailey Kirsten Ritchie Nick Sanders Your email Dog information (optional) Date in Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 Dog name Sex Male Female Age Date of birth Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 Neutered Yes No Not known Chipped Yes No Not known Chip Number Aggression Choose 0 - No known aggression 1 - Exhibits minor aggressive tendencies 2 - Shown aggression to other animals or human 3 - Serious and repeated aggression Any other information Owner details (optional) Reason for handing in Owner Name Contact telephone Owner email Owner Address Send