Samoyed Rescue Application Form
Applicant Name Occupation Co-Applicant Occupation
Address City State Zip
Home Phone Work Phone E-Mail Address
Due to the wandering nature of the Samoyed, NWSR places dogs in our care only in homes where there is a securely fenced yard. We're sorry, but there are no exceptions. If you would like further explanation, click 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.
Type and height of fence: Please describe the area in which your dog will be exercised and allowed to eliminate:
Do you Rent If renting, name and contact info for landlord: Own
Is this a House Apartment Condo/Other
Do you have Children living at home? Yes If Yes, what are their ages? No
Have you owned dogs before? Yes If Yes, what breeds? No
What happened to them?
Does the entire family want a dog? Yes No If no, please explain:
What other animals live in your home?
What do you know about Samoyeds and what about the breed attracts you?
Do you have a preference for: Male Female Either
Do you have a preference for: Purebred Only Purebred or Mix
Minimum or Maximum Age Preference? Yes If Yes, what is your preference? No
What member of the family will primarily be taking care of the dog?
Will the dog be kept (please check all that apply):
Inside Outside In Yard Loose Kennel Garage Basement Other:
Have you ever taken a dog through Obedience Class? Yes If yes, where: No
If you move, what will you do with the dog?
Who is your veterinarian? (Name and phone number)
How else have you tried to obtain a Samoyed?
Will you allow a Samoyed Rescue representative to visit your home? Yes No If No, why not?
How did you hear about us?
Is there any other information you would like us to know? (optional)
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 adoption process and disqualifies me from adopting a Samoyed. Northwest Samoyed Rescue reserves the right to refuse any applicant. We ask for a $150 adoption fee to offset our costs, payable at the time of adoption.
By clicking below, I indicate that I understand and agree to the paragraph above.
Please be patient. It may take up to 60 seconds after you click before the screen changes.
