BERNESE MOUNTAIN DOG CLUB OF SOUTHERN
CALIFORNIA, INC.
ADOPTION
APPLICATION
Name: ___________________________________________________________
Address: _________________________________________________________
Phone:
Home ________________Work_______________ Cell_____________
Referred by: ______________________________________________________
Veterinarian: ______________________________________________________
1. Type
of dwelling: ____ House____ Condo____ Apt_____ Own____ Rent
2. Do
you have fencing? _____ Yes____ No If yes, what type? ___________
3. Why
do you want a Bernese Mountain Dog?
________________________
___________________________________________________________
4. Have
you ever owned a dog before? ________ What type? ____________
5. Do
you have other animals? ___ List type and number________________
6. Do
you have children? List number and ages_______________________
7. Where
will the dog be during the day?_____________________________
At night?_____________________________________________________
8. Do
you prefer a:_____ male_____ female_____ no preference
9. Are
you willing to have a member of the BMDCSC Rescue Committee visit
your home prior to adoption? ___________
10. Are
you willing to accept follow-up phone calls and/or home visits? _________
11. Do
all family members want a dog? _______
12.
Who will be responsible for the dog's care? ___________________________
13.
Do you work? ____Occupation:_____________________________________
14. How
many hours a day will the dog be left alone? __________When
alone,
where will it be kept? ____________________________________________
15. What
will you do with the dog if you are called out of town or go on vacation? ____________________________________________________________
16. Will
you agree to return the dog to the BMDCSC Rescue Program should you
become unable to keep the dog? ________
17. Do
you have any additional comments? _________________________
________________________________________________________
Signature: ______________________________________________
Please return completed form to:
Kathy Gray
714-738-8099
bernerwd@aol.com