Submitter Info
(required) |
First Name: |
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Last Name: |
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Address: |
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(Use for additional or foreign address info) |
City: |
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State / Prov: |
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Postal Code: |
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Phone: |
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Country: |
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Email: |
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If Submitter is not Owner or Breeder,
please explain:
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If this is an
update to a dog already in the Berner-Garde Database, click the checkbox here,
enter the dog's registered name and then enter only the data to be added or
changed, including owner and breeder info.
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Owner Info (Where
the dog lives) Check to use Submitter Info: |
First Name: |
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Last Name: |
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Address: |
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City: |
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State / Prov: |
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Postal Code: |
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Phone: |
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Country: |
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Email: |
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Co-Owners (if any): |
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Breeder/Litter Info
(Please provide as much information as possible) Check to use Submitter name &
address:
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Breeder First Name: |
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Breeder Last Name: |
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Address: |
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City: |
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State / Prov: |
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Postal Code: |
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Phone: |
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Country: |
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Email: |
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Sire Registered Name: |
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Sire Call Name: |
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Sire Reg #: |
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Dam Registered Name: |
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Dam Call Name: |
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Dam Reg #: |
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Litter Birth Date: |
Year:
Month:
Day:
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Dog Info |
Berner-Garde Dog ID: |
(optional but helpful)
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Registered Name: |
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Call Name: |
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Sex: |
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Registration #1: |
Registry 1:
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Registration #2: |
Registry 2:
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Ltd Registration: |
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DNA Registration #: |
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Spayed/Neutered: |
Date of Spay/Neuter:
Year:
Month:
Day:
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Frozen Semen Avail: |
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Available At Stud: |
What's This? |
Microchip: |
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Chip Location: |
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Chip Number: |
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Chip Registry: |
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Tattoo: |
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Tattoo Description: |
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Tattoo Location: |
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Dog Height: |
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Dog Weight: |
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Eye Color: |
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Tail Set: |
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Coat: |
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Bite: |
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Umbilical Hernia: |
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Rescue Type: |
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Health Info |
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It is our goal to show all health data as diagnosed. In order to do this, we will
need a copy of the vet or pathologists report. This can be scanned and emailed,
or faxed, or snail mailed. Please contact the Berner-Garde Database Managers at
manager@bernergarde.org in order
to do so. Thank you in advance for taking the time to do this.
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Deceased: |
Date of Death:
Year:
Month:
Day:
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Cause of Death: |
Please help!
Euthanized:
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Veterinarian: |
(please include address info if possible) |
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Other Health Info:
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Date: |
Type: |
Evaluated By: |
Results or Cert #: |
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By clicking the "Submit Data" button below I am stating that the above data is
correct and accurate to the best of my knowledge and that I voluntarily submit
the above data for entry into the Berner-Garde database. I authorize release
in accordance with Berner-Garde policies, including affected phenotypes at the
time I owned the dog(s) and I authorize a Berner-Garde Site Operator to contact
me for data validation purposes. I understand that phenotypes that were diagnosed after I relocated a dog
are treated as "hearsay" information until verified with the current owner.