Pre-Adoption Questionnaire

Please Read:     Owning a dog requires both a financial and a time commitment. On average, expenses for a healthy Samoyed generally run upward of $600-$1,000.00 a year, just for food, toys, treats, vaccinations, heartworm preventative, flea preventative, yearly vet visits, etc. And that doesn't include trips to the groomer, which can cost $60-$100 or more. Additional costs could include training classes, kenneling or petsitting if you go on vacation, etc. and even a relatively minor medical emergency can easily run over $800. Dogs need to be exercised, and played with, and given attention. They have to be trained, and cleaned up after, and fed. They want to be with you when you are home and travel with you when you aren't. If Samoyeds do not receive sufficient exercise and attention, they will frequently bark, dig, or chew. Samoyeds often live 12 to 14 years, and can live as long as 18! Consider future plans such as children, moving, etc., and how they might impact your commitment to a dog. Please be sure you are ready to expend the time and money necessary to give a dog a home for the rest of its life.

First and Last Name:			Occupation:
Co-Applicant's Full Name:			Occupation:
Street Address
City:			State:	AK AL AS AZ AR CA CO CT DE DC FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY		Zip:
Home Phone:			Work Phone:
Cell Phone:			Email:

How did you hear about us?
If there is a particular dog you would like more information about, which dog(s)?
(Dogs are listed on here)
A successful adoption depends on matching the right dog with the right home. So that we may assist you with this selection please answer the following questions as completely and as honestly as possible. Thanks.

Housing Arrangement:	Rent House Own House Rent Apartment Rent Condo/Townhouse Own Condo/Townhouse Other
		If renting, do you have permission from Landlord to have a medium or large-sized dog?    Yes   No
		Landlord's phone:	(Include area code)
		List Other:

How many adults live in your household?:

Ages:

How many children live in or frequently visit your household?:

Ages:

Have you ever owned a dog before?

Yes   No

Breeds:

What happened to them?

Ages and breeds of dogs currently in your household?
Does the entire household want the dog?   Yes   No
What other types of animals live in your house?
What do you know about Samoyeds and what about the breed attracts you?
Would you consider adopting a Samoyed mix?   Full-bred Samoyed only   Would consider a mix
Gender preference?   Male   Female   Either
Minimum age preference?       No Preference
Maximum age preference?      No Preference
Is your yard fenced?   Yes   No        Fence height and type:
If you do not have a fence, how will the dog be exercised and allowed to eliminate?
What member of the family will primarily be taking care of the dog?

Where will the dog primarily be kept when people are at home?	Loose in House Crated in house Tied in Yard Loose in Yard Kennel Garage Basement Run Loose Outside Other	If other please specify:
Where will the dog primarily be kept when people are NOT at home?	Loose in House Crated in house Tied in Yard Loose in Yard Kennel Garage Basement Run Loose Outside Other	If other please specify:
Where will the dog sleep at night?
Have you ever taken a dog through obedience?   Yes   No     Where?
Are you willing to take this dog through obedience training if needed?   Yes   No
If you move, what will you do with the dog?
What veterinarian do you use or have you used in the past or do you plan to use?
May we contact your veterinarian?   Yes   No
Veterinarian's city and phone number?
How else have you tried to obtain a Samoyed?
Are you willing to allow a SFSR representative to visit your home?   Yes   No
If no why not?
Questions or Comments:

All of the information I have provided on this application is to the best of my knowledge true and complete. I understand that falsifying answers on this application, or at any other time during the adoption process disqualifies me from the adopting of a Samoyed from SFSR.

I hereby Authorize this electronic signature submittal to serve as my legal signature.

Signature (enter  full legal name  for digital signature):  
Co-Applicant (enter full legal name for digital signature):
Today's Date:  


We reserve the right to refuse any applicant.

The usual adoption donation ranges from $250 to $500, depending on the dog's expenses. Checks should be made payable to San Francisco Samoyed Rescue. We are a 501(c)3 nonprofit corporation. Your donation is 100% tax deductible.