Applications

Denver Samoyed Rescue

Application for Adoption

To help ensure the best possible placement of our rescued dogs, and in order to determine that the proposed adoption is in the best interest of both the dog and you and your family, please complete each of the following. Please be thorough as incomplete applications will not be considered. If you have any questions, please feel free to contact a DSR worker.

Name _____________________________________________ Date ________________

Address ________________________City _____________ State _____ Zip ________

How long at current address? _______________________________________________

Telephone Number(s) Home: (_____)________________________

Work: (_____)________________________

Fax: (_____)________________________

E-Mail Address: __________________________________________________________

With whom are you employed? _____________________________________________

Spouse's employer? _______________________________________________________
Occupation(s) ____________________________________________________________

Number and ages of children living in household: _______________________________

What type of area do you live in? City _____ Suburb _____ Rural _____

What type of housing? Apt. _____Condo _____ Duplex _____ House _____ Other ____

Do you rent or own your home? _____________________________________________

Do you live in a covenant controlled community/subdivision? Yes _____ No _____

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

Yes_____ No_____

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

to own a dog? Yes _____ No _____

to own a Samoyed? Yes _____ No _____

May we contact your landlord? Yes_____ No______

Landlord's phone number: (_____)___________________________________________

Landlord's address: _______________________________________________________

What dogs/pets have you previously owned? ___________________________________ ________________________________________________________________________
________________________________________________________________________

Why are they no longer living with you? _______________________________________
________________________________________________________________________

What other types of animals live in your home? _________________________________

________________________________________________________________________

How have you educated yourself about Samoyeds? ______________________________

________________________________________________________________________

Why do you want one? ____________________________________________________

________________________________________________________________________

How did you hear about our Samoyeds and who referred you to us? _________________
________________________________________________________________________

Do you have any preference to the sex of the dog? Male ___ Female ____ Either _____

If so, why? _____________________________________________________________

Do you have any age preference? ____________________________________________

Would you consider a dog that is not exactly your preference? Yes ______ No _______

Do you have a fenced yard? Yes _____ No_____ Height of fence _________________

Chain link _____ Wood _____ Other/Describe ___________________________

If you do not have a fenced yard, where and how will the dog be exercised and be allowed to eliminate? _____________________________________________________

What member of your family will be taking the MAJOR responsibility of caring for this Samoyed? _______________________________________________________________
What are your plans and goals for this dog? ____________________________________
__________________

Have you ever trained a dog in obedience classes? Yes _____ No _____

Will you take your Samoyed to obedience classes? Yes _____ No _____

Will the dog live in the home? Yes _____ No _____

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

______________________________________________________________________________

Do you believe in using dog crates? Yes _____ No _____

What are the major activities, hobbies, or exercises you and your family participate in?

________________________________________________________________________

If you move, what will you do with your dog? __________________________________

________________________________________________________________________

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

________________________________________________________________________

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

Name: _________________________________________________________________
Address: _______________________________________________________________

Phone: _________________________________________________________________

How will your dog travel to the vet or other places? (in a car, van, back of pickup, etc.)

________________________________________________________________________

Do you mind if we call your vet to ask how you take care of your animals? Yes___No __

If yes, why? _____________________________________________________________

If you do not have a vet who is familiar with you, please list two non relatives and their phone numbers whom we can contact about you.

_____________________________________________________________________________

Have you ever surrendered a pet of yours to an animal shelter or sold or given one away? If so, why? ______________________________________________________________

______________________________________________________________________________

May we visit your home to verify the information you have provided? _______________

_____________________________________________________________________

In the space below, please tell us a little about yourself and why you feel you could provide a good home for a rescue dog.

Thank you for taking your time to complete this application. By signing below, you attest to the truthfullness of your answers. Falsification of any of the above infomation will be grounds to disallow your adoption of a rescued dog.

__________________________________ ___________________________________

Applicant Signature Applicant Signature

(If there are two responsible adults in the household, both must sign as an applicant)

WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT

Complete and return to: Denver Samoyed Rescue

PO Box 1564.

Arvada, CO 80001-1564

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(Do not write below this line)

Accepted: ___________________ Interviewer: ________________ Date: _________

Rejected: ____________________ Reason: __________________________________

Suitable dog: ____________________________________________________________

Comments:


	a Denver Samoyed Rescue Application for Adoption To help ensure the best possible placement of our rescued dogs, and in order to determine that the proposed adoption is in the best interest of both the dog and you and your family, please complete each of the following. Please be thorough as incomplete applications will not be considered. If you have any questions, please feel free to contact a DSR worker. Name _____________________________________________ Date ________________ Address ________________________City _____________ State _____ Zip ________ How long at current address? _______________________________________________ Telephone Number(s) Home: (_____)________________________ Work: (_____)________________________ Fax: (_____)________________________ E-Mail Address: __________________________________________________________ With whom are you employed? _____________________________________________ Spouse's employer? _______________________________________________________ Occupation(s) ____________________________________________________________ Number and ages of children living in household: _______________________________ What type of area do you live in? City _____ Suburb _____ Rural _____ What type of housing? Apt. _____Condo _____ Duplex _____ House _____ Other ____ Do you rent or own your home? _____________________________________________ Do you live in a covenant controlled community/subdivision? Yes _____ No _____ If so, are you aware of any restriction and/or regulations concerning pet ownership? Yes_____ No_____ If you rent or lease, do you have permission from your landlord: to own a dog? Yes _____ No _____ to own a Samoyed? Yes _____ No _____ May we contact your landlord? Yes_____ No______ Landlord's phone number: (_____)___________________________________________ Landlord's address: _______________________________________________________ What dogs/pets have you previously owned? ___________________________________ ________________________________________________________________________ ________________________________________________________________________ Why are they no longer living with you? _______________________________________ ________________________________________________________________________ What other types of animals live in your home? _________________________________ ________________________________________________________________________ How have you educated yourself about Samoyeds? ______________________________ ________________________________________________________________________ ________________________________________________________________________ Why do you want one? ____________________________________________________ ________________________________________________________________________ How did you hear about our Samoyeds and who referred you to us? _________________ ________________________________________________________________________ Do you have any preference to the sex of the dog? Male ___ Female ____ Either _____ If so, why? _____________________________________________________________ Do you have any age preference? ____________________________________________ Would you consider a dog that is not exactly your preference? Yes ______ No _______ Do you have a fenced yard? Yes _____ No_____ Height of fence _________________ Chain link _____ Wood _____ Other/Describe ___________________________ If you do not have a fenced yard, where and how will the dog be exercised and be allowed to eliminate? _____________________________________________________ What member of your family will be taking the MAJOR responsibility of caring for this Samoyed? _______________________________________________________________ What are your plans and goals for this dog? ____________________________________ __________________ Have you ever trained a dog in obedience classes? Yes _____ No _____ Will you take your Samoyed to obedience classes? Yes _____ No _____ Will the dog live in the home? Yes _____ No _____ Where EXACTLY will the dog sleep at night and be kept when there is no one at home? ______________________________________________________________________________ Do you believe in using dog crates? Yes _____ No _____ What are the major activities, hobbies, or exercises you and your family participate in? ________________________________________________________________________ If you move, what will you do with your dog? __________________________________ ________________________________________________________________________ When you go on vacation, where will your dog go and who will care for it? __________ ________________________________________________________________________ Who is the veterinarian that you have or would use? Please provide all information. Name: _________________________________________________________________ Address: _______________________________________________________________ Phone: _________________________________________________________________ How will your dog travel to the vet or other places? (in a car, van, back of pickup, etc.) ________________________________________________________________________ Do you mind if we call your vet to ask how you take care of your animals? Yes___No __ If yes, why? _____________________________________________________________ If you do not have a vet who is familiar with you, please list two non relatives and their phone numbers whom we can contact about you. _____________________________________________________________________________ Have you ever surrendered a pet of yours to an animal shelter or sold or given one away? If so, why? ______________________________________________________________ ______________________________________________________________________________ May we visit your home to verify the information you have provided? _______________ _____________________________________________________________________ In the space below, please tell us a little about yourself and why you feel you could provide a good home for a rescue dog. Thank you for taking your time to complete this application. By signing below, you attest to the truthfullness of your answers. Falsification of any of the above infomation will be grounds to disallow your adoption of a rescued dog. __________________________________ ___________________________________ Applicant Signature Applicant Signature (If there are two responsible adults in the household, both must sign as an applicant) WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT Complete and return to: Denver Samoyed Rescue PO Box 1564. Arvada, CO 80001-1564 »«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»«»« (Do not write below this line) Accepted: ___________________ Interviewer: ________________ Date: _________ Rejected: ____________________ Reason: __________________________________ Suitable dog: ____________________________________________________________ Comments:


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