Data Collected On This Form Is Used In Three Portions Of The Database - People Records, Dog Records, & Phenotype Records.
| LAST NAME of owner where dog lives | CO-OWNER if any |
| FIRST NAME | SPOUSE |
| STREET | CITY |
| STATE | ZIP | COUNTRY | PHONE |
| DOGS REGISTERED NAME |
| LITTER NUMBER | CALL NAME |
| BIRTHDATE | DEATHDATE | SEX: __M __F __Neutered/Spay |
| REGISTRATION NUMBER | TITLES | TATOO, CHIP or DNA |
| BREEDERS NAME | BREEDERS KENNEL NAME AND ADDRESS |
| SIRE'S REGISTERED NAME | REGISTRATION NUMBER IF KNOWN | CALL NAME |
| DAM'S REGISTERED NAME | REGISTRATION NUMBER IF KNOWN | CALL NAME |
| PHYSICAL CHARACTERISTICS that you wish to record (height, weight, blue
eye, bite, cleft palate, umbilical hernia, etc.) |
IF DEAD, is cause known? _________________________________________________________ Euthanasia? __Yes ___No
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). I understand that phenotypes that were diagnosed after I relocated a dog are treated as "hearsay" information until verified with the current owner.
Signature: ___________________________________________ Date: __________________
RESULTS FROM GENETIC DISEASE HEALTH REGISTRIES:
(Submit copies of existing reports or ask forBerner-Garde Guidebook which contains application forms)
GDC: Open format with access to affected as well as normal evaluations: both orthopedic and soft tissue genetic diseases(e.g., eyes) of many breeds, set up to evaluate genotype as well as phenotype.
BMD TUMOR STUDY: All data entered as open from owner to be released at time of publication of study results.
OFA: Confidential format with access only to normal evaluations, registries for hips & elbows, set up to evaluate phenotype only.
SEND COMPLETED FORM TO: File Manager - Margrit Kitchen, 9401 E. Jadecrest Dr., Sun Lakes AZ 85248 (email-mkitchen@aol.com) or to your site operator listed in the Berner-Garde Guidebook