Samoyed Club of

Central Arizona Rescue

Email address:

Internet Address:

PROSPECTIVE HOME APPLICATION

This completed questionnaire will help us pick the very best dog for you, your family and your lifestyle. It is very important that we find the correct home for every rescued Samoyed in our program. Completing this questionnaire will tell us whether you would do better with an active or lazy, soft or dominant, independent or submissive dog.

Please fill out ALL of the information requested. An incomplete application will be discarded. (Use as

many sheets of paper as necessary).

Information About You

  1. Name: ______Date: ______
  1. Address: ______City: ______State: ___ ZIP: ______
  1. Email Address: ______
  1. How long at current address: ______
  1. Telephone number(s):Home: (_____) ______
  1. Work: (_____) ______
  1. With whom are you employed? ______

Spouse? ______

  1. Occupation(s): ______
  1. Number and ages of children living in household: ______
  1. If there are no children in the house, do you have children that visitor home on a regular basis? Yes ___ No ___
  1. What type of area do you live in?City ___Suburb ___Rural ___
  1. What type of housing?Apt. ___Condo ___Duplex ___House ___Other ___
  1. Do you rent or own your home? ______
  1. If you rent or lease, do you have permission from your landlord:

To own a dog?Yes ___No ___

To own a Samoyed?Yes ___No ___

  1. What other dogs have you previously owned?

Breed SexNeutered/Spayed Age What happened to them?

______

______

______

______

  1. What other types of animals live in your home? ______

______

  1. Are all the pets present in your household up to date on their vaccinations? Yes ___ No ____
  1. Are ALL household members in complete agreement to adopting, caring for, and training a Samoyed? Yes ___ No ___
  1. Do any family members have allergies? If so, please specify what kind. ______
  1. What do you know about the Samoyed as a breed? ______

______

  1. How did you hear about our Samoyeds, and who referred you to us? ______

______

Information for Finding the Right Samoyed
  1. Do you have a preference to the sex of the dog? Male ___ Female ___ Don’t Care ___

If so, why? ______

  1. What is your age preference? ______Why? ______
  1. Are you aware that Samoyeds are 'people' dogs and will want to live inside with their

Human family?Yes ___ No ____

  1. Will the dog live in the home?Yes ___No ___

If not, where? ______

  1. Where EXACTLY will the dog sleep at night and be kept when there is no one at home?

______

______

  1. Will it annoy you if the Samoyed gets up on your sofa or your bed? Yes ___ No ___
  1. If yes, how would you train the dog not to get on the furniture? ______

______

  1. What type of personality/activity level are you comfortable with in a dog? ______

______

  1. Would you be willing to adopt a senior dog (8+ years old) or special needs dog?

Yes ____ No ____ Maybe ____

  1. a)Do you have a fenced yard?Yes ___No ___Height of fence ______

b)Describe your fence (type, construction, etc) ______

c)If you don’t have a fence, where and how will the dog be exercised and be allowed to

eliminate? ______

  1. What member of the family will be taking the MAJOR responsibility of caring for this Samoyed?

______

  1. What are your plans and goals for this dog? ______

______

  1. Have you ever trained a dog in obedience classes? Yes ___No ___
  1. Will you take your Samoyed to an obedience class if needed? Yes ___No ___
  1. Do you believe in dog crates? Yes ___ No ___
  1. What are the major activities, hobbies, or exercises you and your family most participate in?

______

  1. If you move, what will you do with your dog? ______

______

______

  1. When you go on vacation, where will your dog go and who will care for it? ______

______

  1. Do you understand that Samoyeds are a large breed of dog and that some of the Rescues will come with minimal training and may need a large amount of patience? Yes ___No ____

Care of Your Samoyed

  1. Who is the veterinarian that you have or would use? Please provide all information:

Name: ______

Address: ______

Phone: ______

  1. How will your dog travel to the Vet or other places? (In a car, can, back of a pickup truck, etc)

______

  1. If something happened to you, who would care for the dog?______
  1. Do you mind if we call your Vet and ask how you take care of your animals? Yes ___ No ___

If Yes, why? ______

  1. Are you willing to allow a (SCCA Rescue) representative to periodically visit your home?

Yes ____ No ____ If no, why? ______

  1. Please list the names, addresses, and phone numbers of two (2) personal references (not related)

that you have known for at least two (2) years:

a)______

______

b)______

______

  1. Please tell us a little about yourself and why you feel you could provide a good home for a rescue

dog and why you want a Samoyed: ______

______

______

______

OTHER ITEMS

  1. Would you like to become involved in Samoyed Rescue?Yes ___ No ___

By Fostering? Yes ___ No ___

By Other ways such as grooming, transporting, etc? Yes ___ No ___

  1. Would you be interested in joining the local National Samoyed Club? Yes ___ No ___

Agreement

I am at least 21 years of age. All of the information I have given is true and complete. I understand that SCCA Rescue (AZ Sammy Rescue) has the right to refuse my application.

______

(Signature of applicant)

Thank you for your interest in AZ Sammy Rescue. We appreciate the time it took to fill out this application. After receiving your application, we will contact you via E-mail or a phone call. We will carefully try to match your lifestyle and needs with an available Samoyed ASAP, depending on the waiting list and our available dogs. If you get a Samoyed from another source, or change your mind about adopting from us for any reason, please notify us so we can remove you from our waiting list

Email completed application to the following online address:

Or Please contact azsammyrescue at 602-721-6131

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