• Name:
  Address:
  City:
  Province:
  Postal Code:
  Phone:
  Email :
  

• Do you have a fenced yard?

  Yes No
  

• If No, why?

  
  

• Why are you looking for a Samoyed? Select all that apply.

  Companion
  Conformation
  Breeding
  Obedience
  Agility
  Sledding or carting
  Other
  

• If Other, specify:

  
  

• Do you intend to crate or kennel train?

  Yes No
  

• If No, why?

  
  

• How often do you expect to groom your Sam?

  3 times a week 2 times a week once a week every 2 weeks once a month
  

• Is the dog to be kept

  Indoors Outdoord
  

• Where will the dog Sleep?

  
  

• Will the dog be left outside while you are not home?

  Yes No
  

• How long will the dog be left alone during the day?

  less than 2hours 2-4 hours 4-6 hours 6-8 hours more than 8 hours
  

• How often do you go out at night?

  less than twice per week 3 times per week 4 times per week 5 or more per week
  

• How many adults are there in your home?

  
  

• How many children are there in your home?

  
  

• What are the ages of the children?

  
  

• Are you planning on having children?

  Yes No
  

• Are there any other animals in your house?

Yes No

• Will you Spay or Neuter your pets?

  Yes No
  

• If No, why?

  
  

• How often will you walk your Dog?

  
  

• Do you have any comments you would like us to know?