O'Blako Samoyeds Application Form

O'Blako Samoyeds Application Form
Date of Birth*

MonthDayYear
You must be over 18 years of age to apply.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState/Province

Zip CodeCountry
Gender*

MaleFemaleOther
Which choice best describes your family dynamic?*

I live with one or more adults, but no dependent childrenI live with one or more adults and dependent childrenI live with one or more dependent children, but no other adultsI live alone
Please list all the adults (including you) and/or children in your household, and their ages.*
If you need to add other family members or people living in the household or you are currently under special/temporary living circumstances, please elaborate here.
Does anyone in the household have any allergies to dogs?*

YesNo
Please describe their allergic reaction(s), including the types of symptoms they experience and how severe their symptoms are, and if the person has met and reacted to Samoyeds in the past, and how they plan to deal with their allergies (OTC medication, prescribed medication, immunotherapy shots, minimize time spent with/around dog, etc.).*
Are you currently a student?*

YesNo
Please describe your student housing arrangement. Include how many people you live with and when you will be graduating.*
Which answer best describes your residence location?*

Large citySmall city/TownSuburb/ExurbRural small town/village/hamletIsolated rural (huge lot, widely separated from neighbors by vast stretches of land)Other
Do you own or rent your residence?*

I ownI rent
Have you obtained permission to own a Samoyed from your landlord?*

YesNoIn progress
Which answer best describes the type of home you live in? Please be aware that puppies will need to be let outside to pee frequently, so potty-training will be difficult if you live in an apartment or condo on the upper floors of a multistory building.*

Single-family houseMulti-family homeTownhomeDuplex/triplex/etc.ApartmentCondoManufactured/mobile homeOther
What is the approximate indoor square footage of your home?*
Regarding your residence, please indicate your current containment situation. Please be aware that Samoyeds, due to their high energy level and high prey drive, will happily run loose for great distances to chase after things that interest them if not properly contained outside, and this can result in the dog getting lost or hit by cars. Proper containment is absolutely necessary if you plan to ever let your dog outside unsupervised for any amount of time.*

Secure fenced yard 5+ feet highSecure fenced yard less than 5 feet highSecure kennel run/enclosureI plan to tie my dog outI plan to use electric fencingNo containment plans at presentI don't/won't have containment so I will exercise my dog on a leash
What is the approximate square footage of the fenced area of your backyard?*
Do you have a swimming pool?*

Yes, fencedYes, unfencedNo
On average, how many hours per day will your Samoyed be required to be left home alone?*

N/A; There is always someone at homeLess than 2 hours2-4 hours4-8 hours8+ hours
I have access to and am willing to use a doggy daycare (puppy) or dog walker (puppy and/or adult) if I must be away from home for more than 4 hours per day:*

Willing to use doggy daycareWilling to use dog walkerWilling to use both doggy daycare and dog walker as requiredNot willing to use daycare/walker servicesN/A; I am away less than 4 hours per day
I want a dog that:*

Is a housedog living indoors with the family and accompanying the family when engaging in outdoor activitiesA dog that spends some time in the house with the family but primarily lives outdoors or in a garage/basementA dog that lives outdoors exclusivelyOther (elaborate below)
Please elaborate here on your lifestyle and living arrangements as they affect your dog.*
Me/my family has time to adequately exercise a dog:*

Once a day for 1 hourTwo times per day for 1 or more hours each timeMany times per dayI won't have time to devote to exercising a dog
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' and safe/secure place when he cannot be directly supervised.*

YesNoMaybe
Would you be willing to take your dog to obedience and or socialization classes, and to train him/her to be a good canine citizen?*

YesNoMaybe
When I/we go away on vacation, etc., my/our dog would be looked after by:*

N/A; dog will accompany me/usBoarding kennel or vetFriend/family/neighborPaid dog sitter
Have you considered if it's likely that a dog will still be a welcome part of your family 5 - 10 years from now?*

Yes, my future looks stableUnsure beyond the next 1-2 yearsPotentially unstable
If for any reason you could not keep your Samoyed at any point during its lifetime, would you be willing to return him/her to us to find a new suitable home, and furthermore will you agree not to advertise your dog as available for sale or free on social media, online or paper classified ads, etc. - but rather to notify us and work with us to get the dog back to us?*

Yes, I would be willing to return the dog to you to rehomeNo, I wouldn't return the dog and would try to sell onlineNo, I wouldn't return the dog and would give to a friend or relative
Do you currently own any pets?*

YesNo
Please describe/list ALL currently owned pets, their species, breed/variety/type, age, gender, how long you have had them for, whether they are spayed/neutered, their experience being shown/bred/worked/competing in performance events and trials while under your ownership (if applicable), their personality/temperament, and any chronic health or behavioral issues they have (if applicable).*
Have you previously owned any pets?*

YesNoNo, but I have experience working with domestic animals as a pet-sitter, vet, vet tech, groomer, trainer, kennel worker, handler for shows/trials/performance events/dog sports/working animals/service animals, etc.
Please list ALL previous pets you have owned, their species, breed/variety/type, age they lived to, gender, how long you had them for, their experience being shown/bred/worked/competing in performance events and trials while under your ownership (if applicable), their personality/temperament, any chronic health or behavioral issues they had (if applicable), why you no longer have them (if it's not because they passed away), and what you would have changed about them, if anything.*
Please describe in detail the extent of your experience working with domestic animals.*
Do you currently have or have access to a reliable veterinarian?*

YesNoStill Looking
Please provide the name of your veterinarian and their vet practice's address, website (if available), and phone number below.*
Have you ever raised a litter of puppies or kittens or been involved in any kind of animal breeding? If yes or a family member has, please give details in next field.*

YesNoNot me, but another family member has
Please describe in detail the extent of your or your family member's experience with breeding animals.*
I have researched the Samoyed breed and feel it would be an excellent choice for me/my family:*

YesNoStill debating
Why have you decided to get a Samoyed?*
Are you considering any other dog breeds?*

YesNo
Which other breeds are you considering? Why?*
Have you ever owned a Samoyed before?*

YesNoI had/have regular contact with one via a relative/friendI have cared for someone else's Samoyed temporarily as a pet-sitter
Please describe the extent of your experience caring for Samoyeds.*
Please describe your previous Samoyed(s) in detail. Include their call name, registered name (if applicable), age they lived to, gender, how long you had them for, their experience being shown/bred/worked/competing in dog sports or performance trials while they were under your ownership (if applicable), their personality/temperament, any chronic health or behavioral issues they had (if applicable), why you no longer have them (if it's not because they passed away), and the breeder/kennel/shelter where you obtained him/her/them from. If you already described them in your answers to the questions about your previous pets, write N/A.*
What time frame are you looking to obtain a Samoyed?*

As soon as possible, I'm ready!In a month from now2-3 months from now4-6 months from now6-12 months from nowA year or more from now
Please elaborate on the reason why you are looking to obtain a Samoyed a year or more from now. *
I would like to do the following with my Samoyed: (you can choose multiple answers for this question)*

Compete in dog showsBreedingCompete in dog sports/performance events/trials/tests (i.e. agility, obedience, rally, flyball, disc dog, dock diving, heelwork to music/canine freestyle, herding/farm dog, weight pull, dogsledding races, lure coursing, barn hunt, scentwork/nosework, trick dog, etc.)Service/guide dogTherapy dogProfessional working dog (full-time sled dog, search and rescue dog, detection dog, full-time scent tracker/trailer for police/military/etc., herding dog for a ranch/farm, etc.)Hunting dogOther
None of these; I just want a family pet!
Please describe below in as much detail as possible your previous experience with breeding and/or exhibiting dogs or other animals.*
Please describe below any special circumstances or needs, as they relate to the type of dog you're looking for, that you'd like us to be aware of.*
I am looking for a:*

Puppy (2-12 months old)Adult dog (>12 months old)No preference; either is fine
My preferred age range for a puppy is:*

Young puppy (8-16 weeks; 2-4 months)Older puppy (16-52 weeks; 4-12 months)I don't care/no preference
My preferred age range for an adult dog is:*

Young adult dog (12-24 months)Adult dog (24+ months)Senior dog (7+ years)I don't care/no preference
Regarding gender, I am seeking:*

MaleFemaleFlexible on gender
Do you have any objection to spaying/neutering your Samoyed?*

No objectionWill sterilize upon maturityI object; I do not want to sterilize my dogI am looking for a show or breeding dog so he/she can't be sterilizedOther (elaborate below)
Please elaborate on the reasons for your objection to spaying/neutering your dog.*
Do all members of the family want to get a Samoyed?*

YesNoStill discussing
In terms of grooming, I have time to groom my Samoyed:*

Every dayEvery other day2-3 times per weekOnce per week + professional groomer for bathing/blow dry several times per yearI don't have time to groom a dog
Picking up a dog/puppy from us (we live near Philadelphia, Pennsylvania):*

I will drive to pick up the puppy from you in person at your homeI will fly to pick up the puppy from you at your nearest airportI will pay for transport services to have the puppy delivered to my locationI will drive to pick up the puppy from you in person at a mutually agreed-upon halfway meeting point
GENERAL COMMENTS BOX: Please use this space to add your comments and any questions you might have for us. That's it! We'll get back to you shortly. Thank you for your interest in O'Blako Samoyeds!
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