Central Florida Samoyed Rescue

The most successful adoptions are created by matching the right dog with its best possible household. Please answer ALL of the following questions to assist us in finding the dog most suited to you. (We reserve the right to refuse an applicant.)

Please note: Our volunteers are concentrated in the Central Florida (Orlando/Tampa) area. By completing this application, you agree to meet with a CFSR representative and to take possession of a rescue Samoyed (if approved for adoption) within CFSR's normal area of operation.

**Personal Information**
First Name
Last Name
Address
City
State
Zip	-
Home Phone	- -
Work Phone	- - ext.
E-mail
Best time/method to contact you

**Housing Information**
What is you current housing status?	Rent Own
If renting, is the landlord agreeable to dog ownership?	Yes No
If renting, are you able to supply a copy of the renter's policy or written permission on pet ownership?	Yes No
Which of the following best describes your current type of home?	Apartment/Condo Townhome Single family home Other
Is your yard currently fenced?	Yes No
If yes, please describe the type of fencing.
Do you padlock your gates (if applicable)?	Yes No

**Family Information**
Please answer the following for each adult.
How many adults are living in the household?
	Name	Age range	Occupation	How long Employed?
Adult 1
Adult 2
Adult 3
Adult 4

Are there or are you planning to have children living in the household?				Yes No
If yes, how many children (please include both current and planned)?
Please list the specific ages of current children

Are there other adults or children who visit your home on a regular basis?				Yes No
Please provide additional information regarding your regular visitors such as ages and any specific questions or concerns relating to their interaction with a dog.

Does anyone in the house or who visits regularly have any known allergies to or fear of dogs?				Yes No

**Pet information**
Have you ever owned a dog before?
What types of pets are currently living in your household?
Please provide additional information regarding your current pets such as ages and any specific questions or concerns relating to their interactioon with a new dog.
If yes, please answer the following about current and previous dogs.
	Name	Breed/Type	How long did you own it? (Years/months or still have)	What happened to it? (please be specific - died of what or given to whom)
Dog 1
Dog 2
Dog 3
Dog 4

What activities did you do with them?(obedience classes, talking for walks, etc.)


How did you correct or train this (these) dogs?
Are (were) your last dog(s) on heartworn prevention?				Yes No
Would you be willing to supply a copy of veterinary records on this (these) dog(s) and/or allow us to contact your veterinarian?				Yes No
If yes, please provide the following for your current or most recent veterinarian.
Name
Address
City, State, Zip
Phone Number

**Desired Characteristics**
Many older dogs make wonderful companions and have great manners. Please consider one. Younger dogs do also require a lot more work.
How did you hear about our Samoyed rescue?
How did you learn about the Samoyed breed?
What is your reason for choosing this breed?
Do you have a gender preference?	Either Male Female
What is your reason for this gender preference?
Do you accept that the dog will be neutered or spayed?	Yes No
Do you have a preferred age?	None 0 - 2 years 3 - 5 years 6+ years
Reason for this age preference?
Would you consider adopting an older dog?	Yes No
Does the entire family want this dog?	Yes No
Have you ever previously applied for or adopted a dog from rescue?	Yes No
If yes, what were the rescue group's name and the dog's name at time of adoption (if applicable)?

**Samoyed Characteristics**
Samoyeds are primarily a herding and sledding breed. As such, they can be runners, barkers, diggers, chewers, and usually have a tendency to pull on lead. They are also a double-coated breed which requires a lot of grooming time.
Are you aware of and prepared to handle the characteristics of the breed.	Yes No

**Responsibility**
Who will be primarily responsible for taking care of the dog? (Feeding, walking, grooming, etc.)
Would you be willing to take this dog to obedience classes (if needed)?	Yes No
Are you willing to house break a puppy?	Yes No
If yes, what is your method of house breaking?
Do you own a crate to house the dog while unattended?	Yes No
Where will the dog be primarily kept?	Inside Outside Access to both through dog door
How many hours a day would the dog be left alone?
What best describes where the dog will primarily be when left alone (even if only for a short time)?	Inside: Loose inside home In garage In kennel/crate confined to specific area or room Outside: In fenced yard In kennel/dog run Tied to tree or stake Both: Access to both through dog door

**Long term care**
The life expectancy of a Samoyed is 10 -15 years.
Are you willing and prepared to commit to caring for a dog for this length of time?	Yes No
Under what circumstances do you think you might need to return a dog (e.g. moving, job change, change in family status, etc.)
If something happened to you, who would care for this dog?

**Budget and Emergency Care**
In addition to the normal, everyday care and cost of a dog, emergency situations or special needs may arise.
What would you estimate as the normal annual cost of caring for a Samoyed? (include food, heartworn & flea/tick preventative, vaccines, crate, bedding, toys, grooming, etc.)
Will the cost of caring for this dog fit comfortably into your budget?	Yes No
Would you be able to handle the additional costs of an emergency situation?	Yes No
An average Samoyed weighs 35 to 65 pounds, possibly more.
Would you be able to lift a dog of this size that is unable to walk due to injury or illness (or readily get assistance with lifting)?	Yes No
Would you be able to handle the additional costs and other needs of a dog that has or develops a permanent medical condition?	Yes No Depends on the type of condition
Florida is the heartworm capital of the world. Heartworms come from mosquitoes biting the dog.
Are you aware of the cost of preventing or treating heartworm?	Yes No

**Activities**
Are there other things you might like to try or learn more about or do with your dog? e.g. volunteer to assist Rescue, obedience, agility, weight pull/carting, hiking/backpacking, herding, therapy, grooming, joining national or local Samoyed breed club.
What are your plans for this dog?	Pet Obedience Guard Therapy Herding Other If other please explain:

**Rescue costs**
Rescue is supported by individuals. Some dogs may have extensive medical conditions which must be handled before the dog can be placed. As such, CFSR requests a donation of $300.00 to help offset these costs.
Are you agreeable to this?	Yes No

**Behavior Agreement**
Some of these dogs may have histories of abuse or neglect. If accepted, you will be required to sign an Adoption Agreement, which recommends that the adopted dog be watched initially for signs of destructive behavior or aggression. CFSR will not knowingly place an aggressive dog. If this behavior is noticed, there are steps to take such as verbal and physical praise but only verbal disapproval, etc.
Do you agree to isolate or otherwise handle any destructive/aggressive behavior appropriately without the use of physical discipline?	Yes No

**Final comments**
Can you please tell us a little about yourself and your family? (Your home, job, hobbies and interests, etc.)

Do you have any questions or comments?

I understand that a dog can be unpredictable and that CFSR cannot anticipate or insure against unexpected conduct of an adopted dog from CFSR. I acknowledge that CFSR has not made through its volunteers, any warranties regarding the future condition, temperament or conduct of the dog. I hereby agree to accept an adopted dog as is, assume all risks and responsibilities associated with adopting this dog, including bites, and I hereby fully and completely release, indemnify, and hold harmless CFSR, its directors, volunteers and agents from any claim, cause of action or liability of any sort or nature, whether, known or unknown, directly arising out of or in connection with the ownership, care, maintenance, retention, temperament, conduct or condition of the dog. CFSR will never knowingly place an ill, injured or poorly socialized dog in an adoptive home without first apprising the adoptive family of the situation. Thank you for your application.
To the best of my knowledge the foregoing information is true and I have read and understand the above disclosure.	I agree
Date:
Signature:

If you have further questions, please contact us. Please note that on-line applications and email inquiries are preferred when possible.

Welcome to

Central Florida Samoyed Rescue, Inc.

Adoption Application