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Rescue Adoption Application

This completed application will help us determine 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 form 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.

Name:             E-Mail:
Street:             Phone: 
City:             State:            Zip: How long at residence?
Type:                 Own? Yes          City?     
                                                          No           Suburb?
                                                                               Rural?   
If you rent, do you have permission   Yes                                       
from landlord to have pets?                No                                                                                                                                                              
 No. of children & ages:

Employer:    How long?
Address:  
City:              State:       Zip: Work Phone:
Occupation:


What other dogs do you currently have or have previously owned?

What other animals live in your home?                            
 
Who referred you to us?
What do you know about the Samoyed breed?


Why do you want to own a Samoyed?                           

Do you have a preference of sex of the dog?   If so, which do you prefer and why?

Do you have a fenced yard? If so, what type of fence and what height?  If not, how will the dog be exercised and be allowed to eliminate?

What member of the family will be taking the major responsibility for the care of the Samoyed?

Will the dog live in your home? Yes No If not, where will it live?

Where exactly will the dog sleep at night and when you are not home?
When you are on vacation, where will your dog go and who will take care of it?

If you move, what will you do with the dog?
Do you believe in the use of dog crates?             Yes         No
Have you ever trained a dog in obedience class? Yes         No
Are you willing to let an NTSRI representative visit your home? Yes    No
Please provide the following information about your veterinarian:
Name:     Phone:
Address:     City:     State:     Zip:
May we contact your veterinarian for a reference? Yes     No

Please list information of two references who have known you for at least two years (no family, please).
Name:         Name:    
Address:         Address: 
City:                    City:       
State:                        Zip:               State:                     Zip:

Please tell us a little about yourself and why you feel you would provide a good home for a rescued Samoyed.
 
By clicking the "Submit" button below, you acknowledge that the information provided here is true and correct, and that no misrepresentations have been made by you. This is an application only and does not entitle you to any dog in our program unless and until it is approved and a separate Adoption Agreement has been entered into between you and NTSRI.  Additionally, your submission certifies that no one in your household has ever been convicted of animal abuse/animal cruelty.