Your full name:

Your email address: (e.g.: you@aol.com)

Details of your family's residence:
City/house
City/appartment
Country/house
Country/appartment
Condo
Other, please describe in the GENERAL COMMENTS box

Do you have any objections to spaying or neutering your new puppy by 5-6 months of age?
No objection. I agree with sterilization of pets
Yes I object. I want my dog to remain whole
May consider it when mature
OK, after one litter
N/A, I want an adult altered dog

If you don't currently have any children, are you planning to start a family in the future?
Yes
No
Our children are grown and left the nest

Have you ever had to put a dog to sleep (i.e., euthanasia)?
Yes
No

Have you ever raised a litter of puppies? If yes, please give details:

Have you ever had to take an animal to a shelter or pound? If yes, provide details.

Do you currently have a veterinarian? If so, please provide his/her name.

Have you researched the Samoyed breed and feel its characteristics suit you and your families lifestyle?
Yes
No
Undecided

My perception of Samoyeds is that they ...
Shed
Bark when bored
Dig
Are angelic entities that engage in none of the above!
Are great and social
Are territorial Guardy dogs
Need little supervision
Are the perfect breed for us

I am familiar with and am willing to use a dog kennel (crate), wire or moulded plastic, to aid in housebreaking and training my dog - as well as to provide him with his own 'den'.
Yes
No
I will research this

In terms of grooming, I think Samoyeds require: (check all that apply)
daily brushing
weekly combing/brushing
full bath/blow dry every 6 months
Groomer twice a year
I don't know

How many people (children/adults, ages) including yourself reside at your residence?

Do other members of the family want to get a puppy?
Yes, all
Most, but still under discussion
N/A - I live alone

What are your plans for your hoped-for new addition? Check all that apply.
Personal companion
Personal companion,may want to show
Show dog
Breeding
Maybe breeding
Agilty/Flyball/Obedience competitions
Dog for the kids

Would you be willing to take your dog to obedience classes, and to train him/her to be a good canine citizen?
No, not necessary
Yes, absolutely
No classes in my area

Why have you decided to get a Samoyed?

Please describe details of any current or previous family pets, including their health, how long they lived, how they died (if deceased), and what traits you enjoyed, or would have changed if you could.

Are you seeking a:
Baby Samoyed puppy (8-12 weeks)
Older Samoyed puppy (4-12 months)
Samoyed adult
Undecided/flexible

Do you have a preference for a:
male
female
no preference/flexible

Are you primarily seeking:
Outdoor dog
A dog that spends time living both indoors and outdoors
House dog, only out with family

Do you have a pool, if so is it fenced?
No pool
Pool - fenced
Pool - unfenced

How will you safely contain a dog? Please check all that apply.
Kennel run (existing)
Kennel run (will build)
Have fenced yard (5ft high)
Have fenced yard (6ft+ high)
Planning to erect a fence soon
No fence, will walk my dog everyday
No fence, will tether/chain/rope
No restraint - my dog can run loose

Your complete address: street, city/town, Province/State, Postal/Zip code

Phone number (include area code please)

Were you referred to LINROSA Samoyeds by some source? Please state how you found us.

GENERAL COMMENTS BOX. Please use this space to add your comments and any questions you might have for us.