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*

MonthDayYearHourMinutesAM/PM Option
Tell us about yourself:
Full Name*

First NameLast Name
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing Address** If Different from Physical.

Street Address

Street Address Line 2

CityState / 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

CityState / Province

Postal / Zip CodeCountry
Home Phone Number*

Area CodePhone Number
Work Phone Number

Area CodePhone Number
E-mail*
Contact Method preference

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

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number

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

MaleFemaleEither
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