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Samoyed Club of Austin, Inc.
Adoption Application

This completed questionnaire will help us pick 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 questionnaire will tell us whether you would do better with an active or inactive, soft or dominant, independent or submissive dog.

If you fill out the application electronically, please print the completed application (prior to clicking SUBMIT button), sign and return to:  Samoyed Club of Austin-Rescue, 158 Synergy Dr., Unit E, Bastrop, TX 78602.

Please fill out all of the information requested.  An incomplete application will not be considered and will be discarded!  The more information we have, the better!

 
Applicant:  

Date: 

Co-Applicant:    
Address:

City:    State:     Zip: 

How long at current address: 
 
Phone: Home    
  Work    
  Mobile    
Email:
 
Employer:
Occupation:

Number and ages of children in the household:



 
What type of area do you live in? City
Suburb
Rural		  
   
 
 
What type of housing? Apartment
Condo
Duplex
House
Other
 		  
   
 
 
Do you rent or own your home?
 
If you rent or lease, do you have permission from your landlord to own a medium/large dog? 

 
What other dogs have you previously owned?


 
Where are they now?

 
If there are animals currently living in the household, what are their species, genders and ages?

 
Are you looking for a guardian dog, outdoor or indoor pet?

 		  
Tell us about your previous experience with Samoyeds

 
Please tell us why you want a Samoyed?

 
Are you considering any other breeds? Yes
No
Maybe
 		 If Yes/Maybe, which breeds

 
Would you be interested in a Samoyed mixed breed dog? Yes
No
 		  
How did you find out about the Samoyed Club of Austin Rescue?  Were you referred to us?

 
Do you have a preference for gender? Male
Female
Either
 		  
If you chose a gender preference, why?

 
List an age preference, if any:    

 
Who will be taking primary responsibility as caregiver for the dog?

 
How will you be exercising the dog?

 
Where will the dog be allowed to eliminate?

 
Please tell us about your lifestyle?  Are their hobbies you enjoy?
 
Where will the dog be when no one is home?  Where will he/she sleep at night?

 
Do you have a fenced yard? Yes
No
 		      
Type of fence? Wood
Chain link
Other
 		 Other, describe
  
Height of fence? Less than 3'
3'
4'
 		 5'
6'
8'
 		  
Do you own a crate/crate train your dog(s)?

 
Would you be able to take your Samoyed to obedience training, if necessary?

 
Who will care for your dog when you are out of town? (i.e. vacation, business, etc.)

 
Are you willing to allow a SCA (Austin) representative to periodically visit your home?  Yes   No
 
If not, please explain:    

 
Name, address and phone number of veterinarian reference:
 
Veterinarian:

Phone Number: 

 
Address:

City:    State:     Zip: 


Names, addresses and phone numbers of 2 personal  references (not relatives) that you have known for at least 2 years:
 
Reference 1:

Phone Number: 

 
Address:

City:    State:     Zip: 
 
Reference 2:

Phone Number: 

 
Address:

City:    State:     Zip: 


 

The Samoyed Club of Austin, Inc. (SCAustin) strongly recommends the use of dog crates, not just for the safety of the items in your home but, ultimately, for the safety of the dog. (A dog that chews can easily suffer devastating ill effects (sometimes fatal) from the consumption of common household items, drywall, carpet fibers, etc.). We also strongly encourage, if at all possible, that dogs be crated inside the vehicle during transportation.

WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT

Note:  Signature required after approval & prior to rescue leaving for their new home

Questions? - Email Rescue at scaustin@hotmail.com
       

Left click the "Submit" button only once to send your application to Rescue, thank you.