Your Name

Address 1

Address 2

Phone

Do you work?

Full time or Part time?

Do you have children in your home?

Ages?

Best time for a new puppy? Winter

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Spring

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Summer

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Fall

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Have you ever owned a Berner?

Why do you want a Bernese Mountain Dog?

I understand the wait can be up to 6 mos or
longer?

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Who is the primary caregiver?

Have you ever raised a puppy?

If so how long ago?

Do you plan to crate train?

Do you have a fenced in yard or exercise plan?

List all pets currently in your home
breed/age/sex.

Are you looking for a Male Show Potential

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Male Pet Quality

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Female Show Potential

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Female Pet Quality

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If show potential, explain why & your plans for
the puppy.

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