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BERP Application – Sample Form

ALL APPLICANTS MUST SIGN AND RETURN THIS FORM IN ORDER TO BE ACCEPTED INTO THE ESSFTA BREEDER EDUCATION AND REFERRAL PROGRAM. THIS APPLICATION IS FOR ESSFTA MEMBERS ONLY, AND SUPERSEDES ANY PREVIOUS APPLICATION TO THE BREEDER EDUCATION AND REFERRAL PROGRAM. THERE IS A THREE YEAR WAITING PERIOD BETWEEN INCEPTION OF MEMBERSHIP IN THE ESSFTA AND ELIGIBILITY FOR THE BREEDER EDUCATION AND REFERRAL PROGRAM.


PLEASE READ THIS SAMPLE FORM BEFORE BEGINNING YOUR APPLICATION.

TO COMPLETE THIS FORM YOU WILL NEED THE REGISTRATION NUMBERS, OFA NUMBERS, MOST RECENT CERF NUMBERS AND PRA AND PFK INFORMATION (ASSUMING THESE TESTS HAVE BEEN DONE) FOR EACH OF YOUR DOGS THAT YOU HAVE BRED OR INTEND TO BREED, INCLUDING ANY STUD DOGS TO WHICH YOU HAVE BRED.

PRIOR TO BEGINNING , READ THROUGH THIS SAMPLE APPLICATION AND GATHER UP ALL INFORMATION AND NUMBERS NEEDED TO COMPLETE THE FORM. YOU MAY ALSO INDICATE IF YOU WILL BE MAILING , FAXING OR EMAILING UNDER SEPARATE COVER THE ACTUAL TESTING AND REGISTRATION DOCUMENTS SHOULD YOU WISH TO DO SO.

BELOW YOU WILL FIND AN EXAMPLE OF A PARTIALLY COMPLETED BERP APPLICATION. THE INFORMATION HERE IS A REPRESENTATION OF THE INFORMATION NECESSARY TO SATISFY THE REQUIREMENTS OF THE APPLICATION.


Contact Information:

Name:
Email:
Website:
Phone:
Street:
City:
State:
Zip:
Kennel Name:

Please Tell Us About Yourself.
Please Provide Names and Certificate Numbers of Status in the Areas Provided.

Are you a returning BERP Member?
___ Yes     ___ No

Are you a new BERP Applicant?
___ Yes     ___ No

How many litters have you bred or co-red in the last three years?
Please indicate number of litters: ___
Please provide the number of litters you have bred or co-bred within the last three years in the above location.

Do you participate in Cerf?
___ Yes     ___ No
Please provide numbers and/or info here on individual dogs you breed and/or intend to breed.
Example:Annually for every dog who resides in my household. I recommend all owners get their dogs annually CERF’d. I have 6 now: YAHOO 1, RN EN123456789 now microchipped, CH. YAHOO 2, RN EN 123456789 YAHOO 3 EN123456789, CH. YAHOO 4, RN EN EN123456789, CH. YAHOO 5, RN EN EN123456789

Do you OFA and/or Penn Hip?
___ Yes     ___ No
Please provide numbers and/or info here on individual dogs you breed and/or intend to breed.
Example: OFA hips and elbows YAHOO 1, RN EN123456789, CH. YAHOO 2, RN EN123456789 YAHOO 3 EN123456789, CH. YAHOO 4, RN EN EN123456789, CH. YAHOO 5, RN EN123456789 turns 2 in Feb 2011 to do when he turns 2.

Do you have your dogs’ PRA status?
___ Yes     ___ No
Please provide numbers and/or info here on individual dogs you breed and/or intend to breed.
Example: All dogs owned by me since the inception of the DNA blood bank. I will only list the dogs I have currently residing in my house: YAHOO 1, AMGL Case No. 123456 Affected, CH. YAHOO 2, AMGL Case No. 12345 Carrier YAHOO 3 AMGL Case No. 12345 Affected, CH. YAHOO 4, AMGL Case No. 12345 Carrier, CH. YAHOO 5, carrier by parentage but will do blood draw in 2011 and test anyway.

Do you have your dog’s PFK status?
___ Yes     ___ No
Please provide numbers and/or info here on individual dogs you breed and/or intend to breed.
Example: Even though it is not presently recommended. YAHOO 1, ESSPPFK 1234 – Normal, CH. YAHOO 2, ESSPPFK 1234 – Normal YAHOO 3 ESSPPFK 1234 – Normal, CH. YAHOO 4, ESSPPFK 1234 – Normal, CH. YAHOO 5, ESSPPFK 1234 – Normal.

Are these results made available to your “puppy buyers”?
___ Yes     ___ No

Are you involved in conformation?
___ Yes     ___ No

Are you involved in obedience?
___ Yes     ___ No

Are you involved in field trials?
___ Yes     ___ No

Are you involved in rescue?
___ Yes     ___ No

Are you involved in agility?
___ Yes     ___ No

Are you involved in rally?
___ Yes     ___ No

Are you involved in tracking?
___ Yes     ___ No

Are you involved in hunting?
___ Yes     ___ No

Please tell us why you would like to become a member of BERP. Please tell us about yourself and your dogs. If for any reason you have not met one of the guidelines listed below, please explain, and provide any necessary documentation either by mail, fax, or email. (See contact information below.)

Example: I would like to continue to educate prospective ESS owners about the breed, and its health issues.
As a breeder/exhibitor with over 30 years experience my goal has been to place each puppy/dog I produce into loving homes where their full potential might be realized. I require a training deposit which is refunded after the puppy has completed 2 training classes, one of which is a puppy socialization class before the puppy is 1 year of age. This ensures a dog/owner bond and education for a smooth relationship. I have the Puppy Temperament Testing done at 7 weeks of age for all of my litters and make these results available to the new owners. Many prospective owners have witnessed the testing, and it is also taped for further evaluation. I encourage AKC registration and participation in AKC events. Currently an AKC Breeder of Merit.

Please provide information about the litters you have bred or co-bred in the last three years. PLEASE PROVIDE REGISTERED NAMES AND CERTIFICATE NUMBERS OF STATUS IN THE AREAS PROVIDED (ATTACH ADDITIONAL PAPER IF NEEDED) Provide any necessary documentation by mail, fax, or email. (See contact information below.) If you have not bred any litters in the last three years, please just type in NONE.

Example: I hold owners of the stud dogs I use to the same standards as my own dogs with documented testing.

2010 Grand CH. GOOGLE SR123456701 (cerf clear, hips good, pra carrier, pfk normal) X Ch. YAHOO1 ,SR98765402 6 puppies 2 titled at 7 months of age: YAHOO2 RN and YAHOO 3. YAHOO2 went to her new home after her titled was achieved. All others in the litter are spayed/neutered and in pet homes, completed their training classes.

2009 Grand CH. ROADRUNNER SR12345670, (cerf clear, hips good, pra carrier, pfk normal) X CH. YAHOO1,SR98765402 6 puppies CH. YAHOO4, RN achieved both titles in 2010 with Breeder/owner/handler from puppy and BBE wins. Placement in Rally Novice.

2008 YAHOO3 X YAHOO5 6 puppies This has been the only mistake litter I have ever had, conceived while my husband and I were on a 10 day vacation. She was not in season when we left, and was when we returned. I NEVER would have condoned such a breeding! These 2 were half brother/half sister and both still very young, She under 2 yrs of age and He a puppy of 9 months of age both out of CH. YAHOO1. All puppies were sold on spay/neuter agreements and full disclosure was made to new owners on the parents’ relationship. All puppies were DNA PRA tested prior to sale, the 5 girls were all affected, the 1 boy was a carrier. One of the females I PTS as a 2 week old due to a congenital defect that took 2 weeks to diagnose. The 5 remaining puppies are in loving pet homes

Stud dog owners are held to the same guidelines as breeders and co-breeders. Please list any stud service you have provided in the past three years including AKC Registered and registration numbers of sire and dam, dates of birth of sire and dam, and whelp date of litter. Provide any necessary health screening documentation by mail, fax, or email. (See contact information below.) If you have not bred any litters in the last three years, please just type in NONE.

Example: None I do not breed my dogs to any dog which does not have medical clearances of OFA and PRA and annual CERF. I require the same of my own.

To access an application for filing, click here.