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Bernese Mountain Dog Club of the Rockies
Rescue Program Application
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Please fill in this form if you would like to be placed on our contact list for possible adoptions.

You will be contacted only if you are a possible match with one of our rescued dogs.

Press the "Submit" button when complete.

Name and Address:

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

e-mail:

Questions:

Does everyone in the household want a Bernese Mountain Dog? Yes No
Why do you want a Bernese Mountain Dog?
Why do you want a dog from the rescue program rather than from some other source such as a breeder?
How many children in the household?
What are their ages?
Are the children well behaved around pets? Yes No
Do you have other animals? Yes No
What kind of animals do you have?
Will the rescue dog be kept in a fenced area? Yes No
Type of fence?
Height of fence in feet?
Is there adequate shade available in the fenced area? Yes No
Where will the dog be kept during the day?
Where will the dog be kept during the night?
On average, how many hours will the dog be alone during the day?
Do you prefer a male or female rescue dog? (Specifying no preference will increase your chances of getting a rescue dog) Male Female No Preference
What activities do you plan to do with your dog?
Are you aware of the health problems of Bernese Mountain Dogs? Yes No
If so, name two of these prominent health problems.
Have you owned a dog before? Yes No
What breed(s)?
Have you ever surrendered a dog to a rescue program, pound, shelter, or placed a dog you owned in another home? Yes No
If yes, what were the circumstances of the placement(s)?
Philip Shaffer, pshaffer@bmd.org last update 12/28/99
Bernese Mountain Dog Club of the Rockies