Bernese Mountain Dog Club of the Rockies
First NameLast Name

StreetCityState Zip


Approximate Whelp Date (mm/dd/yy)

Are you a  BMDCR member in good standing?

Are both the sire and dam registrable with AKC?

Are both the sire and dam over 18 months of age?

Will the puppies be sold with a health guarantee 
subject to a veterinarian's exam within 48 hour
of sale?

Are both the dam and sire entered in Berner-Garde?

Will you provide a complete litter entry to  Berner-Garde?
SIRE                                                                                     DAM
Registered Name

Registration Number

Date of Birth 

Hip Number*

Elbow Number*

*Hip and elbow numbers are not required to list a litter