Heaven On Earth

Name(s) (Please indicate all names if joint ownership):

Address of Principal Owner (where dog will reside):

Postal/Zip Code:

Home Phone:

Office Phone:

Fax:

E-Mail Address:

How many family members and others are there in your home?

Adults:

Children and Ages:

Do you have a fenced yard?

Please provide a brief description of other animals in your household.

Why do you wish to buy a dog at this time?

Why do you want a Bernese as opposed to any other breed?

Do you own or rent your home?

What type of house do you have eg bi level, bungalow, will the puppy have stairs they need to climb?

Do you prefer a male or female?

Male_____ Female_____

Please describe the “personality” you are looking for in a Bernese

Have you had a Bernese before? If yes, please describe him/her and provide CKC information. If more than one previous Bernese, please indicate how many and describe the last one.

Full CKC Name: ______________________________________________________

CKC Registration #: ____________________________________

What experience do you have with dogs, specifically with raising puppies?

During a typical day, how many hours would the puppy be left alone?

Where will the Bernese be at night?

Week-days:

Week-ends:

Do you have a regular puppy/dog sitter for times when you are away (holidays, etc.)?

Do you have any life style traits that may impact upon the caring for a Bernese? e.g. are you out of town a lot?

Please provide the Name and Telephone Number of your Veterinarian.

Veterinarian’s Name: ___________________________________________________

Practice Name: _______________________________________________________

City/town: ___________________________ Telephone #: ___________________

Are you a member of any Dog Clubs or Associations? Do you plan to be?

CKC Membership # (if applicable)__________________________

Do you plan on participating in dog-related activities?

Conformation Shows____ Sanction Matches_____ Obedience Trials_____

Test Matches_____ Agility_____ Flyball_____ Canine Good Citizen_____

Obedience_____ Other____

Do you plan to use this puppy in a breeding program?

Have you ever bred puppies of any other breed?

Have you read any books on Bernese or about dogs in general?

Will you travel to pick up your pup?

Is there any other information you can provide us that you think may be helpful?