Coburg Hills Bernese Mountain Dogs

Coburg Hills Bernese Mountain Dogs

Michelle & Steven Merfeld

P.O. Box 7874

Springfield, OR 97475

E-mail:

Questionnaire for Prospective Puppy Owners

Thank you for taking the time to fill out this questionnaire so we can understand what you are looking for. When we have litters, we want to make sure our puppies are sold to loving and committed homes for life. Please answer the following questions as completely as you can and mail the form to the address shown above or cut and paste into an email. If you have any questions, please email. All information is confidential.

Family Information:

Name:______

Partner's name:______

Referred by:______

Home address:______

City, state, and zip:______

Mailing address:______

E-mail address:______

Phone number:______

What is your occupation:______

What is your spouse's occupation:______

How many adults live in your home.______

Do you have any children? Ages of children in the home.______

Do any family members have allergies to dogs?______

If your family circumstances change (new baby, change of residence or job) what will happen to the dog?

______

Puppy Information:

What sex are you interested in?

? Male ? Female

? No preference

All our puppies are sold on AKC limited registration and spay/neuter agreements. Do you have a problem with this?

? Yes, why?______? No

Are you currently on the waiting list for any other litters?

? Yes ? No

Why have you decided to buy a Bernese Mtn Dog?______

______

Please rank the following factors in order of importance to you in your choice of a puppy (1=most important):

A.Structure______

B.Markings______

C. Temperament______

D. Sex______

E. Family companion______

F. Potential obedience dog______

G. Pet therapy______

H. Search & rescue______

I. Potential show dog______

J. 4-H or FFA project______

K. Breeding______

L. Other (______)______

Housing Information:

Do you live in:

?Apartment

? Townhouse

? Single-family residence

? Other

Do you rent or own your residence? If you rent, have you discussed a dog with

? Rent your landlord? ? Yes ? No

? Own

Do you plan on moving anytime soon?

? Yes ? No

Do you have a fenced yard?

? Yes ? No

If not, how will you provide security for your puppy when it’s outside or when you're away____

______

Is anyone home during the day?______

Where will this puppy spend the evening? ______

Where will this puppy sleep?______

Are you willing to attend group puppy training classes with this dog as a condition to adopting one of our puppies?

? Yes ? No

How many hours on the average will your puppy spend alone?______

Household Information:

Have you ever owned a Bernese Mountain Dog before?

? Yes ? No

If so, where did you purchase it from?______

If you haven't owned a Bernese Mountain Dog before, what other breed of dog have you owned?

______

Do you still own the dog(s) mentioned above? ? Yes ? No

If not, what happened to the dog(s)______

______

Please list all pets currently in your household______

______

Who will have primary responsibility for the care of this puppy? ______

______

Do all family members agree on the addition of a Bernese Mtn Dog to the family?

? Yes ? No, why?______

Please give us the name, address, and phone number of your veterinarian (or one that has worked with you in the past

______

Have you ever returned a dog to the breeder? If so, what were the circumstances?

______

Have you ever been charged with animal abuse or neglect?

? Yes ? No

Have you ever given a dog away? What were the circumstances?______

______

Have you ever bred a dog/dogs before? If so, please elaborate.______

______

Please give us any other information you think will help us get to know you and your needs with respect to placing a puppy most suited to your family/lifestyle:

______

As a condition for having one of our puppies, we require that if some unforeseen circumstances happen, that the dog be returned to us. Do you agree to follow this requirement? ? Yes ? No

Although we strive to produce healthy Bernese Mtn Dogs do you understand and agree that there is no guarantee that the puppy/dog purchased from us will be free of genetic defects although proper screening of both parents is done?

? Yes ? No

Thank you for taking the time to fill out this questionnaire and provide us with important answers. Sincerely, Steve and Michelle

______

Signature(s) Date

COBURG HILLS BERNESE MOUNTAIN DOGS

PO BOX 7874, SPRINGFIELD, OR 97475