NEMDA Mortality Report
Our deepest condolences on the loss of your beloved family member.

We greatly appreciate you filling out this report. We know this is hard but understand that this will help the breed that we all love so dearly.

Our best to you during this difficult time.


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Disclosure Statement

The National Entlebucher Mountain Dog Association (NEMDA) provides and maintains a pedigree database at EntlebucherDatabase.nemda.org. Information entered in this form is added to the database by NEMDA. Knowing which dogs had specific maladies helps owners, breeders, and researchers to improve understanding of the cause and heritability of many health conditions. 

Do you consent to your information being a part of the pedigree database? 

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What is your name? *
Are you currently a NEMDA member? *
What is your departed dog's registered name? What is their call name? *
If registered with AKC, what is the dog's registration number?
In which US state or Canadian Province did your dog live most of it's life? *
How would you classify the area in which your dog lived most of it's life? *
Was your dog euthanized or did it pass naturally? *
What was your dog's age at the time of death?
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What was your dog's gender? *
Was your dog used for breeding or stud? *
Did you have a necropsy performed? *
What was the cause of death? *
What was the date of your dog's passing? *
MM
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DD
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YYYY
If Cancer was involved, please note what type:
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Would you like to have your dog recognized on NEMDA's Obituary Page? *
Are there any other details you think it would be helpful to share?
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