Berner-Garde Database Litter Submission Form

Type in data then click the "Submit Data" button to send the information to Berner-Garde.

Submitter Info (required)
Name:
Address:	(Use for additional foreign address info)
City:
State / Prov:	Alabama Alaska Alberta Arizona Arkansas Armed Forces - America Armed Forces - Europe, Africa & Middle East Armed Forces - Pacific Australian Capital Territory British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N.W. Territory Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New South Wales (Australia) New York Newfoundland & Labrador North Carolina North Dakota Northern Territory (Australia) Northwest Territory (Canada) Nova Scotia Nunavut Territory (Canada) Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Queensland (Australia) Rhode Island Saskatchewan South Australia South Carolina South Dakota Tasmania (Australia) Tennessee Texas Utah Vermont Victoria (Australia) Virginia Washington West Virginia Western Australia Wisconsin Wyoming Yukon	Postal Code:
Phone:		Country:	Andorra Argentina Australia Austria Bahamas Belgium Bermuda Brazil Canada Chile Croatia Czech Republic Denmark Ecuador Estonia Finland France Germany Great Britain Greece Hungary Iceland India Ireland Israel Italy Japan Lithuania Mexico New Zealand Norway Poland Romania Russia Scotland Slovakia Slovenia South Africa Spain Sweden Switzerland The Netherlands Ukraine United States of America Uruguay
Email:
If Submitter is not Breeder, please explain:
	If this is an update to a litter already in the Berner-Garde Database, click the checkbox here, enter enough information to identify the specific litter, then enter the data to be added or changed.
Breeder Info   Check here to use Submitter name & address:
Breeder Name:
Address:
City:		State / Prov:	Alabama Alaska Alberta Arizona Arkansas Armed Forces - America Armed Forces - Europe, Africa & Middle East Armed Forces - Pacific Australian Capital Territory British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N.W. Territory Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New South Wales (Australia) New York Newfoundland & Labrador North Carolina North Dakota Northern Territory (Australia) Northwest Territory (Canada) Nova Scotia Nunavut Territory (Canada) Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Queensland (Australia) Rhode Island Saskatchewan South Australia South Carolina South Dakota Tasmania (Australia) Tennessee Texas Utah Vermont Victoria (Australia) Virginia Washington West Virginia Western Australia Wisconsin Wyoming Yukon
Postal Code:		Country:	Andorra Argentina Australia Austria Bahamas Belgium Bermuda Brazil Canada Chile Croatia Czech Republic Denmark Ecuador Estonia Finland France Germany Great Britain Greece Hungary Iceland India Ireland Israel Italy Japan Lithuania Mexico New Zealand Norway Poland Romania Russia Scotland Slovakia Slovenia South Africa Spain Sweden Switzerland The Netherlands Ukraine United States of America Uruguay
Phone:		Kennel Name:
Email:
Litter Info
Litter Whelp Date:		Litter Registration #:
Sire Registered Name:
Sire Call Name:		Sire Reg #:
Dam Registered Name:
Dam Call Name:		Dam Reg #:
Insemination Method:	Natural AI - Frozen AI - Fresh Chilled AI - Fresh Unchilled Frozen Implant	Birth Method:	Natural C-Section
Total Surviving Males:	(Alive at 8 weeks)	Total Surviving Females:	(Alive at 8 weeks)
Stillborn Males:		Stillborn Females:
Neonatal Death Males:		Neonatal Death Females:
Note: We are using the term "Neonatal Death" to describe a puppy that was born alive but died before it was 8 weeks old.
Puppy List

Puppy #1:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #2:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #3:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #4:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #5:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #6:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #7:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #8:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #9:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #10:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #11:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone
Puppy #12:	Reg Name:		Call Name:
	Reg Number:	AKC:	Sex:	Male Female
	Limited Reg:	Yes No		Stillborn Neonatal Death
	Owner Name:		Owner Phone #:
	Owner Address:	Private Addr/Phone

Additional Comments:
By clicking the "Submit Data" button below I am stating that the above data is correct and accurate to the best of my knowledge and that 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) and I authorize a Berner-Garde Site Operator to contact me for data validation purposes. I understand that phenotypes that were diagnosed after I relocated a dog are treated as "hearsay" information until verified with the current owner.

  Please direct any questions or comments about this form to filemanager@bernergarde.org.