BARC Application for Adoption

BARC Application for Adoption
BARC, Inc. reserves the right to refuse any application without providing reasons to the applicant for such refusal.

Please Note : Due to the volume of applications, we only keep applications on file for 6 months. If you have not received a contact within 6 months, please resubmit your application.
Today's Date *

Month Day Year Hour Minutes AM/PM Option
Tell us about yourself:
Full Name *

First Name Last Name
Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Mailing Address** If Different from Physical.

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Length of time at this address *
years
Previous Address if at current address for less than 2 years

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number *

Area Code Phone Number
Work Phone Number

Area Code Phone Number
E-mail *
Contact Method preference

Phone eMail
If renting, please provide the landlord's address and phone number below.
Full Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number

Tell us about the BMD you are looking for:
Is there a particular rescue Berner you wish to adopt?
Sex Preference *

Male Female Either
What is the ideal age range that you would consider adopting? *
What characteristics are you looking for in a BMD? *
What else would you like the BARC Adoption Committee to know: Please add any additional comments or questions. If you would like to speak with a BARC, Inc. representative, please message BARC, Inc on Facebook.
Should be Empty:

Additional Information