Adoption Application

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Cell/Mobile
Pager
Work Phone
Home Phone
FAX
URL
E-mail
Employer
Position
How Long?
Veterinarian
Vets Phone #

       Personal Reference:

          Do you rent or own?

Rent
Own

 If Renting - Do you have Landlord's written permission?

Yes
No
Verbal Only

Please provide the following contact information for your Landlord:

Name
Work Phone
E-mail

 

  Do you live in a:

House Apartment Condo Mobile Other

Do you have a fenced yard?
Yes
No

         What kind of fencing?

Wooden
Chain Link
Brick
Wire

         Fencing Height?

6' & over
5 ft
4 ft
3 ft & under

       Previous experience with dogs (summarize).

        Why do you no longer have your previous pets?       

`        Family situation (children, ages, extended family)

Are you familiar with crate training?

Yes
No
Maybe

Would you be willing to use this method?

Yes
No
Maybe

Have you ever housebroken a puppy?
Yes
No

What methods did you use?

Who will be responsible for the dog?

Does everyone in the family want a dog?

Yes
No
Maybe

Do you allow dogs inside your home?

Yes
No
Maybe

What other animals live with your family?

Where will this dog live?

Does anyone in your family have an allergy to dogs?

Yes
No
Maybe

Why are you interested in a Samoyed?

What kind of Sammy do you want (age, sex, personality)?

Will you consider a Rescued Samoyed who needs a great home?

Yes
No
Maybe

How else have you tried to obtain a Samoyed?

Are you willing to allow a home visit? 

Yes
No
Maybe

If not, why?

 

All of the information I have provided on this application is, to the best
of my knowledge, complete and accurate.  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 Pyles Of
Smiles.