Thank you for your interest in Denver Samoyed Rescue. Before filling out this application, please take some time to think about the

following questions. This may help determine whether a Samoyed is the right breed for you. These questions address some

of the reasons Samoyeds end up in rescue.

§ Why do you want a Samoyed? § Are you a compulsive cleaner? Master gardener? § How do you feel about hair on your clothing, furniture, etc.? § Who will groom the dog? § Who will scoop up after the dog? § Will the dog participate in family outings and activities? § Are you away from home a lot both day and night?

§ Are you willing to spend time retraining a dog? § Would having a baby make you decide you no longer need or have time for a dog? § If you have children, how do you plan to keep your dog from getting out the door or gate? § Do you prefer a calm, quiet greeting when you come home over a boisterous, enthusiastic greeting?

To ensure the best possible placement of our rescued dogs, and that the proposed adoption is in the best interest of all parties,

please complete each of the following sections. An incomplete application or misrepresentation of any facts on

this application is grounds for refusal. If you have any questions or concerns,

please feel free to discuss them with a DSR volunteer (303-453-1360).

Part I – Household/Family

Name(s):				Date
Address:		City		State		Zip+4
How long at current address?
Telephone Number(s):	Home		Work		Fax
E-Mail Address(es):
Who is your employer?
Occupation:
Spouse’s employer:
Occupation:
Ages of children living in, or frequently visiting, your household:

Part II – Residence

What type of area do you live in?

City

Suburb

Rural

What type of housing?

Apt.

Condo

Duplex

House

Other

Do you live in a covenant-controlled community/subdivision?

Yes

No

If so, are you aware of any restrictions and/or regulations concerning pet ownership?

Yes

No

If yes, what are they?

Do you rent or own your home?

Own

Rent

If you rent or lease, do you have permission from your landlord:

To own a dog?

Yes

No

If yes, are there any weight/size restrictions? Please state.

To own a Samoyed?

Yes

No

May we contact your landlord?

Yes

No

Landlord’s phone number:

Landlord’s address:

Do you have a fenced yard?

Yes

No

Height of Fence

Type of fence:

Chain Link

Wood

Other/describe:

Note: Invisible fences are not considered appropriate for Samoyeds.

Part III – Current/Previous Pets

Have you, or anyone living in your household ever owned a Samoyed?			Yes	No
What dogs/pets have you previously owned?	Type(s)
Why are they no longer living with you?
Please list all other animals currently living in your home.		Type:
		Age:
		Gender:
Please describe your child(ren)’s previous experience with dogs:

Part IV – Rescue Samoyeds

How have you educated yourself about Samoyeds?	Books	Internet	People	Please explain below:
Why do you want one?
How did you hear about Denver Samoyed Rescue and who referred you to us?