Name:

Address:

City, State, Zip:

 Phone Numbers (Home/Work):

Best Time and place to reach you: 

Email Address:

Occupation:

Do you prefer a male or female?  Male Female No Preference

Why?

Have you ever owned a dog before? Yes No

Why have you decided to purchase a Samoyed?

For what purpose are you purchasing this puppy? (Family Pet, Companion?)

Are there other animals in the home? Yes No

Please describe pets other then dogs you presently own or have owned in the last 5 years. - (Names, species, ages).

Children (please list ages):


Are ALL Family members in agreement on getting a Samoyed Puppy? Yes No  

Do any family members have allergies to or fear of dogs? Yes No

What leisure activities and hobbies do you and other family members enjoy?

Who will be the primary caretaker?
 

Is this person aware of the time and endless energy needed to care for a young puppy and willing and able to accept that responsibility? Yes No

Will the cost of raising and caring for this puppy fit comfortably into your budget? (Initial puppy shots, monthly heartworm medication, annual booster vaccinations, crate, bedding, food, toys, grooming products, spaying or neutering). Yes No

Are/Were your present or past dogs spayed or neutered?  Yes No

If not why?

Are your present dogs kept on heartworm preventative year round?  Yes No

If not why?

Are you committed to caring for this dog for his/her lifetime? (Average life span is 11-13 yrs) Yes No

What would cause you to have to give up the dog?

 Do you own or rent?  House, Condo, Apartment, Other?  Rural, Suburban or Urban Area?
 

Where will your puppy be staying during the day? At night?  While you are away from home?
 

Do you have a fenced in yard?  Please describe it if you do.

What type of outdoor facilities do you have? Securely fenced yard, kennel run. Invisible fence. Dog house or other adequate shelter from the elements?

Do you padlock your gates (If applicable)?  Yes No

Do you plan to use a crate for Housebreaking?  Yes No

If not, what other method do you plan to use?

Are you willing to obedience train this dog through training classes in order that he/she will become an enjoyable companion and canine good citizen? Yes No

Do you have experience in any of the following areas? training, showing, breeding, pet therapy work, agility, other. (Please describe, including any titles or achievements earned, number of litters whelped or just general information about other dogs you have owned?

 "All puppies sold as companion dogs require a mandatory spay/neuter
contract. No exceptions.

 Have you ever euthanized a dog?  Yes No

If so, for what reason?

Last, but not least, please describe what type of personality you are looking for in your Samoyed (as an adult dog) and the type of family environment in which he/she will be living:

Please list the name, address, and phone number of your veterinarian for your present pets:

Please use this field for additional information or comments that you feel are important.

 My apologies for the length of this questionnaire but I feel this type of information is very important in choosing just the right puppy for you.  Thank you for taking the time to complete it.