Berner-Garde Database Dog Submission Form

Type in data then click the "Submit Data" button to send the information to Berner-Garde.
Submitter Info (required)
First Name: 
Last Name: 
Address: 
  (Use for additional or foreign address info)
City: 
State / Prov:  Postal Code: 
Phone:  Country:   
Email:   
If Submitter is not Owner or Breeder, please explain:
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.
Owner Info  (Where the dog lives)  Check to use Submitter Info:
First Name: 
Last Name: 
Address: 
 
City: 
State / Prov:  Postal Code: 
Phone:  Country: 
Email: 
Co-Owners (if any): 
Breeder/Litter Info (Please provide as much information as possible)   Check to use Submitter name & address:
Breeder First Name: 
Breeder Last Name: 
Address: 
 
City: 
State / Prov:  Postal Code: 
Phone:  Country: 
Email: 
Sire Registered Name: 
Sire Call Name:  Sire Reg #: 
Dam Registered Name: 
Dam Call Name:  Dam Reg #: 
Litter Birth Date:  Year: Month: Day:   
Dog Info
Berner-Garde Dog ID:  (optional but helpful)
Registered Name: 
Call Name:  Sex: 
Registration #1:  Registry 1: 
Registration #2:  Registry 2: 
Ltd Registration:  DNA Registration #: 
Spayed/Neutered:  Date of Spay/Neuter: Year: Month: Day:
Frozen Semen Avail:  Available At Stud:  What's This?
Microchip:  Chip Location: 
Chip Number:  Chip Registry: 
Tattoo: 
Tattoo Description:  Tattoo Location: 
Dog Height:  Dog Weight: 
Eye Color:  Tail Set: 
Coat:  Bite: 
Umbilical Hernia:  Rescue Type: 
Health Info   
 
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.
Deceased:  Date of Death: Year: Month: Day:
Cause of Death:  Please help! Euthanized:
Veterinarian:     (please include address info if possible)
Other Health Info:
Tests/Certifications:
  All tests and certifications must be verifiable. If they are not already on the OFA or CERF website, please arrange with
the File Manager to provide a copy. See the information above in the Health section of this submission form.
Date:  Type:  Evaluated By:  Results or Cert #: 

Titles Earned:
Additional Comments:
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.
Please direct any questions or comments about this form to manager@bernergarde.org.