Puppy List Registration Form

Bernese Mountain Dog Club of Ireland Puppy List Registration Form

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Mobile Number *

Home Number (if none give mobile number) *

Email *

How many adults in household? Please give names *

How many children in the household? Please give names and ages *

Do all the adults in the household work? *

If not who is at home? *

If all the adults in the household work does anyone come home during the day or at lunchtime? *

Do you have any other pets? Please give details *

Are you familiar with the Bernese Mountain Dog i.e. have you seen the breed and if so where? *

Are all the members of the family in agreement with the decision to acquire a Bernese Mountain Dog? *

Are you looking for a pet/to breed/to show? Please tick any that apply *

Pet To Breed To Show

Are you looking for a dog or a bitch? *

Where will the dog be kept (pen/house/shed/kennel)? *

Do you have a secure garden? *

Please give the name and address of your Vet *

Submit