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 ESSFTA BERP Application
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SAMPLE
FORM
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Breeder Education
and Referral Program
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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. |
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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.
ONCE YOU HAVE SUBMITTED YOUR FORM ONLINE,
YOU WILL THEN SEE A COPY THAT YOU
SHOULD BE ABLE TO
PRINT FOR YOUR RECORDS.
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. |
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Contact Information: |
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Name: |
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Email: |
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Website: |
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Phone: |
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Street: |
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City: |
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State: |
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Zip: |
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Kennel name: |
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PLEASE TELL US ABOUT YOURSELF:
PLEASE PROVIDE NAMES AND CERTIFICATE
NUMBERS OF STATUS IN THE AREAS PROVIDED |
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Are
you a returning BERP Member? |
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Yes
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No |
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Are
you a new BERP Applicant? |
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Yes
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No |
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How many litters have you bred or co-bred in the last
three years?
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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.
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Do you
participate in Cerf? |
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Do you OFA
and/or
Penn Hip? |
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Do you have
your dogs' PRA status? |
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Do you have
your dogs' PFK status? |
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Are these
results made available to your "puppy buyers"? |
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Are you
involved in conformation? |
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Yes
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No |
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Are
you involved in obedience? |
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Yes
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No |
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Are
you involved in
field trials? |
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Yes
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No |
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Are
you involved in
rescue? |
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Yes
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No |
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Are
you involved in
agility? |
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Yes
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No |
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Are
you involved in rally? |
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Yes
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No |
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Are
you involved in
tracking? |
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Yes
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No |
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Are
you involved in
hunting? |
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Yes
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No |
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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.)
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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. |
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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.
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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 |
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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. |
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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. |
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To access an
application for filing
click here |